Origami

M.Hellan This is a male patient with a BMI of 34 and a large anterior midrectal cancer. Due to his obesity a laparoscopic medial to lateral approach is used for mobilization of the left sided colon. A high ligation of the IMA and IMV is performed. The Da Vinci Si system with three working arms is utilized for a total mesorectal excision. First the mesorectum is mobilized posteriorly and laterally all the way to the pelvic floor. The tumor appears attached to the seminal vesicles. Therefore the vesicles are resected en-bloc with the rectum.