Laparoscopic total mesorectal excision (TME) for rectal cancer

Abstract

Details of laparoscopic total mesorectal excision (TME) are described. Except for the divisions of the main vessels, such as the inferior mesenteric artery (IMA), the inferior mesenteric vein (IMV), and the left colic artery (LCA), the procedures consist of continuous dissection between the mesorectum and the surrounding tissues or organs. Essential prerequisites for the dissection are only two: making a good coordinated counter-traction by both the surgeon and the assistant and then recognizing the fibrous tissues between the mesorectum and the surrounding tissues or organs. The positions of assistant’s hands as well as the surgeon’s left hand to make coordinated tractions are described in the figures. As the definitions or images of historically famous terminologies, such as Waldeyer’s fascia, Denonvilliers’ fascia, etc. seem to be different among surgeons, I avoided using them. Instead, to share the images of “fibrous tissues,” the planes created with dividing those fibrous tissues are pasted with half-tone colors. Some histological figures will help you to understand the surgical anatomy of the pelvic floor.