fig3

Figure 3. Three steps of pure NOTES. Pure NOTES consist of three steps: anal (anorectal), intracorporeal, and second anal step. According to each step, TaTME, CME + CVL, and anal completion are performed, respectively. Anal completion can be done by finishing of pull through, transection of specimen, and anastomosis. NOTES: natural orifice transluminal endoscopic surgery; TaTME: transanal total mesorectal excision; CME: complete mesocolic excision; CVL: central vascular ligation