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Total mesorectal resection using perirectal natural orifice transluminal endoscopic surgery (NOTES) access (PNA) was progressively accomplished using endoscopic monopolar scissors (ApolloEndosurgery, Austin, TX, USA) inside the ideal oncologic plane of dissection. The endoscope is inserted directly in the presacral space, from an incision above the dentate line, allowing flexible dissection in the anatomic oncologic plane from below. (Courtesy Brazilian NOTES Research Group).
