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Laparoscopic TME with low colorectal end-to-end anastomosis (stapled) and temporary ileostomy.

Clinical Case:

  • 62 y.o. Male
  • Mid-low rectal cancer – T3N+
  • Preoperative chemoradiotherapy
  • Surgery: laparoscopic TME with temporary ileostomy


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