Abstract:

The middle approach for surgery was chosen, and the uterus was suspended firstly. The mesentery and peritoneum of the sigmoid colon were incised from the sacral promontory, and the mesentery was pulled to the left, the Toldt’s gap between the colonic mesentery and the posterior abdominal wall was revealed. The mesenteric vascular sheath was found and dissected, The IMA and IMV was ligated and cut, and the lymph nodes were dissected. The sigmoid mesangium was pulled to the right to reveal Toldt’s line. The Toldt’s space was freed cephalically here to avoid damage to the left ureter and reproductive vessels. The loose connective tissue space behind the sigmoid mesangial was extended caudally to the posterior rectal space to avoid injury to the inferior ventral nerve and the anterior sacral venous plexus. The avascular space between the mesentery of the rectum and the fascia of the pelvic wall was exposed and blunt separation was performed. Started from the center of the posterior wall, gradually separate was performed to the sides, the rectum sacrum ligament was detached and finally the anterior wall of the rectum was separated. The intestinal wall could be naked at the distal end of the rectum. After the amputation, the tumor specimen was taken out from the anus. Intracavitary anastomosis was performed.

Key words: Rectal neoplasms, Robotics, Surgical procedures, operative