A video of a laparoscopic total mesorectal excision for treating a rectal tumor by Professor Min-Hua Zheng (President of both the Chinese Society of Laparoscopic and Endoscopic Surgery and the Endoscopic and Laparoscopic Surgeons of Asia), Dr Bo Feng, and Dr You Li from Ruijin Hospital and Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China. The steps taken in the video are described as follows: [00:00:05] First, the key structures were identified: the aorta, the origin of the inferior mesenteric artery (IMA), and the sacral promontory. Next, the abdominal cavity was explored and the existence of carcinomatosis confirmed. The compliance of the descending and sigmoid colon was evaluated. [00:00:33] The peritoneum was first incised in the direction of the inferior mesenteric vein (IMV). The peritoneum was dissected at the site of the promontory and along the right border of the aorta until the third part of the duodenum. The IMA was dissected with an UltraCision® harmonic scalpel (UHS) at the site of its bifurcation with the aorta. Care was taken to protect the mesenteric plexus and to not particularly expose it. [00:01:44] The IMA was clamped with two Hemolock™ clips and then cut between the clips. Next, the inferior mesenteric vein (IMV) was dissected at the left side of the IMA with the UHS. The IMV was clamped with the clips and safely cut. [00:02:53] Further dissection along the Toldt's line and the Toldt's fascia, which covers the ...
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