[Standard establishment and standardized implementation of the NOSES type Ⅰ eversion technique for low rectal cancer]

Natural orifice specimen extraction surgery (NOSES) represents a significant advancement in the field of minimally invasive surgery. It has garnered widespread attention in colorectal tumor surgery due to its advantages such as minimal trauma,rapid recovery,excellent cosmetic outcomes,and high patient psychological acceptance. The eversion technique of NOSES Ⅰ for low rectal cancer,performed via laparoscopic or robotic platforms,involves everting the rectum transanally after complete rectal mobilization,allowing for precise determination of the distal resection margin and resection of the distal bowel under direct vision. This technique is a classic and hallmark minimally invasive approach in NOSES. It perfectly integrates the oncological radical principles of total mesorectal excision with the concept of extreme minimally invasive surgery,achieving "no auxiliary abdominal incision" and preserving the integrity of the abdominal wall as a surface organ to the greatest extent while ensuring tumor radicality. This significantly enhances patients' postoperative recovery experience and cosmetic satisfaction. This article aims to systematically elaborate on the theoretical foundation,classification of surgical techniques,standardized operative procedures,indications,standard technical processes,and other related issues of the eversion technique system. Through a systematic review of the standardized implementation and promotion of this technique, the authors hope to provide clear clinical practice guidance for surgical peers and further advance the development of standardized,homogeneous,and precise sphincter-preserving surgery for low rectal cancer in China.