G.S. Choi

SUMMARY: The pneumoperitoneum is induced with the Verres needle and the abdominal exploration does not show carcinomatosis and liver metastases.
The patient is placed in a modified lithotomy position and then tilted in a steep Trendelenburg position.
A medial-to-lateral mobilization of the left colon represents the first part of the operation followed by high ligation with Hem-o-lock and section of the inferior mesenteric vessels. After completion of colon mobilization the dissection continues circumferentially along the mesorectal fascia down to the planned rectal section line, that is identified with intraoperative endoscopy.
Once the TME is completed the assistant divides the distal rectum using a 30-mm linear stapler through a 12-mm laparoscopic port. The specimen is extracted through a left lower quadrant minilaparotomy and the anastomosis is created trans-anally.

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