Longitudinal laparotomy.
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Skin incision and exposure
![Skin incision and exposure]()
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Freeing the left colon
![Freeing the left colon]()
Free the left colon up to the middle of the transverse colon with release of the splenic flexure. Identify and dissect the inferior mesenteric vein, ligament of Treitz and the arterial blood supply.
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Managing the inferior mesenteric vein
![Managing the inferior mesenteric vein]()
High ligation and suture ligation of the inferior mesenteric vein at the inferior aspect of the pancreas.
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Managing the inferior mesenteric artery
![Managing the inferior mesenteric artery]()
After suture ligation of the inferior mesenteric artery close to its origin, divide the artery while sparing the superior hypogastric plexus.
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Entering the lesser pelvis
![Entering the lesser pelvis]()
After instituting Trendelenburg position, open the peritoneum at the base of the mesosigmoid and mesorectum on both sides from anteriorly to the promontory down to the pouch of Douglas, and then open the "holy plain" posterior to the mesorectum, respecting the layers and the hypogastric nerves.
Perform this dissection akin to total mesenteric excision.
Mesorectal dissection
After identification of the ureters continue the posterior dissection within the lateral layer. Str
After identification of the ureters continue the posterior dissection within the lateral layer. Str
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