There is no consensus about the best technique to use for the surgical treatment for large rectal adenomas. The advent of laparoscopic surgery has led to the development of several new methods for the treatment of gastrointestinal tumors. This study was designed to introduce an innovative technique of totally laparoscopic resection with natural orifice specimen extraction (NOSE) for large rectal adenomas and to assess the feasibility and safety of the technique. Between February 2011 and January 2014, we performed totally laparoscopic resection with NOSE on 18 patients with a large rectal adenoma. This new technique was successful in all 18 patients. The average size of the adenoma was 4.2 cm. Mean operation time was 108.4 min, and mean intraoperative blood loss was 36.6 ml. The mean time to passing of the first flatus was 2.3 days, and the mean postoperative hospital stay was 7.2 days. Only one patient needed analgesics after the operation. All patients were able to walk within the first 2 days. There were no cases of morbidity and recurrence. Totally laparoscopic resection with NOSE appears to be suitable for selected patients with a large adenoma located in mid- or low rectum.

We present revised orbital elements for the massive interacting binary HD 163181, and we offer the first evidence of apsidal motion in the orbit (apsidal period yr). We searched for but found no U p 510 ‫ע‬ 100 obvious evidence of the secondary's spectral lines in our optical spectra. We do observe, however, systematic profile variations with orbital phase that probably result from a gas stream from the Roche lobe-filling supergiant to the faint secondary. The relatively small projected rotational velocity of the primary ( km s Ϫ1 ), the V sin i p 88 ‫ע‬ 3 faintness of the secondary, the reported lack of orbital motion in the Ha emission, and the presence of an IR excess all suggest that the system is surrounded by an extensive circumbinary disk (as is found in a similar binary, RY Scuti).

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