Laparoscopic TME

Clinical History:

• Diagnosis of a mid-low rectal cancer, starting 3 cm above the anal verge

• Local staging with ultrasound and MRI – cT3N+

• CT-scan showed no distant metastasis

• Neoadjuvant treatment with chemoradiotherapy

Other History:

• No important medical history

• Surgical history: previous apendectomy

Procedure steps:

• 1. Surgical history: previous apendectomy

• 2. Splenic flexure mobilization with a medial-to-lateral approach

• 3. Inferior Mesenteric Artery (IMA) ligation

• 4. Medial-to-lateral approach with full colonic mobilization

• 5. TME

• 6. Circular stapled anastomosis

• 7. Temporary stoma (ileostomy)

Learning points:

• Medial approach for veins & arteries

• Radial dissection above the pancreas

• TME