Fig. 1

Key surgical steps of NOSES. (a) Five-hole method trocar arrangement; (b) explored the tumor location and marked the distance between the anterior and proximal bowel of the tumor; (c) inserts an incision protector to pull out the anus to make an isolation cavity; (d) Ultherapy opening at the distal and proximal end of the colon; (e) Straight cutting stapler for side anastomosis of the broken end; (f) Proximal colon with nail base; (g) Tubular stapler for end-to-end anastomosis; (h) Absorbable stitches (3 − 0) reinforcement anastomosis opening; (i) Pelvic floor water injection to test anastomotic leakage