This article presents the clinical data and surgical experience of a patient who successfully underwent laparoscopic radical resection for rectal cancer with natural orifice specimen extraction surgery (NOSES) Type IV in a primary hospital. During the initial implementation of this technique in primary healthcare settings, patients with early-stage tumors, moderate tumor size, and non-obese mesentery are preferentially selected to reduce technical difficulty and facilitate a smooth learning curve. The procedure strictly adhered to oncological principles, including total mesorectal excision (TME) and lymph node dissection. Using the standard five-port laparoscopic approach routinely available in primary hospitals, intracorporeal digestive tract reconstruction was completed through close collaboration of a dedicated surgical team, and the resected specimen was successfully extracted transrectally via the natural orifice. The patient recovered uneventfully, with minimal postoperative pain, rapid gastrointestinal functional recovery, a shortened hospital stay, and only several small trocar incisions remaining on the abdominal wall, demonstrating the advantages of minimal invasiveness and superior cosmetic outcomes. We believe that, with appropriate patient selection and standardized operative protocols, laparoscopic NOSES Type IV can be safely and feasibly performed in primary hospitals. This technique not only ensures satisfactory oncological radicality but also maximizes the benefits of ultra-minimally invasive surgery and enhanced recovery, making it a valuable procedure for wider adoption in primary healthcare settings.