Laparoscopic left hemicolectomy of descending colon carcinoma with superior rectal artery （SRA）preservation and natural orifice specimen extraction （NOSE）:a standard operation procedure----with a video

Abstract Background: Laparoscopic-assisted radical resection of colorectal cancer and Natural orifice specimen extraction surgery（NOSES）are widely used around the world. However, due to the low incidence of descending colon cancer, there are still some problems in the application of laparoscopic and NOSES techniques in left hemicolectomy, such as surgical route, blood vessel preservation, dissociation of splenic flexure, specimen pulling out, and intracorporeal anastomosis. Herein, we introduce the technical procedure of laparoscopic left hemicolectomy with Superior rectal artery （SRA）preservation and NOSE. Methods: A retrospective analysis was performed on 39 patients who underwent laparoscopic left hemicolectomy with SRA preservation and NOSE in the Gastrointestinal Surgery Center of Sichuan Cancer Hospital from November 2017 to May 2021. General information about the patients, preoperative data and short-term postoperative results were analyzed. Results: All operations were completed smoothly, with an average operation duration of 227.17 ± 65.51 min , intraoperative bleeding of 91.05 ± 66.71 ml, first time off bed of 11.97±2.15 h, first time to anus exhaust of 20.20 ± 10.08 h, first time to liquid diet of 2.48±0.72 days,and average postoperative stay of 7.66 ± 1.89 days. Two patients developed temporary intestinal obstruction, and one patient developed pulmonary infection. One patient developed chyle fistulay.One patient developed intestinal infection. All of them recovered well after active supportive treatment, and were discharged successfully. Conclusion:Laparoscopic left hemicolectomy with SRA preservation and NOSE is safe and feasible, with satisfactory short-term results, and is worthy of further clinical investigation.