Fig. 1. A Natural Orifice Specimen Extraction (NOSE) approach for rectal cancer. (A) The rectum distal to the tumor was divided using monopolar cautery. (B) During transrectal NOSE, a plastic bag was introduced to remove the specimen through the anus. (C) Double purse-string sutures were applied after placement of the circular stapler. (D) The proximal colon was exteriorized through the vagina to place the anvil after transvaginal specimen extraction.