Laparoscopic Distal Gastrectomy (Billroth I) with Transvaginal Specimen Extraction (GC-NOSES II)

Abstract

The tumor is located in the middle and lower third of the stomach, the stage is T3 or below, and the largest diameter of the tumor is less than 5 cm. After the perigastric lymph node dissection is completed, the greater omentum and the distal stomach is placed in the specimen bag and can be extracted through the posterior vaginal fornix. This procedure with specimen extraction through a natural orifice is referred to as NOSES II for gastric cancer, which is mostly applicable to female patients with cosmetic requirements for the abdominal wall. This procedure does not require auxiliary incisions in the abdominal wall to extract the specimen out of the body. After the surgery, only a few tiny trocar scars are left on the abdominal wall, which makes this procedure a truly total laparoscopic radical gastrectomy. This procedure not only has a good cosmetic appearance on the abdominal wall but also reduces the incidence of postoperative pain and infection caused by additional auxiliary incisions. The surgeons should have clear understanding of the indications and contraindications of this procedure.