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With the transected vascular pedicle retracted, dissection then proceeds down into the pelvis. For cancer operations, the authors dissect at the least 5 cm distal to a cancer. If the tumor is within the very distal rectum, a decrease midline or Pfannenstiel incision is usually required to facilitate publicity and transection of the rectum at the extent of the anorectal ring. A complete mesorectal excision (TME) is carried out for all low rectal cancers, and sphincter preservation is feasible if there's a 2-cm mucosal margin above the dentate line. For diverticular operations, the authors dissect to the higher rectum the place the taeniae coli coalesce. As soon as the distal margin is recognized, the bowel is transected with an endoscopic stapler. The authors then divide the distal mesocolon or mesorectum with an power gadget and proceed up the affected person's left aspect, dividing the white line of Toldt. The authors routinely mobilize the splenic flexure to acquire sufficient size for performing an anastomosis.

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