Nerve Preserving Laparoscopic Total Mesorectal Excision (TME) - A Didactic Video Vignette.

Resecting the rectum within an intact mesorectal fascial envelop is the oncological rationale behind total mesorectal excision (TME)1. The pelvis has a rich autonomic nerve supply that has contributions from the abdominal sympathetic plexus, the pelvic splanchnic nerves and the superior and inferior hypogastric plexuses. These nerves not only supply the rectum but course around the mesorectal fascia to supplythe urogenital organs. A detailed knowledge of the neural anatomy of the pelvis and the sites of common nerve injury is vital to avoid nerve injury while still ensuring a complete TME. Laparoscopy for rectal cancer is an accepted standard of care, however it does require a specialized skills set to ensure oncological adequacy 2. The surgical approach to the procedure can be further modified to avoid nerve injury without compromise in oncological adequacy. This didactic video presents our technique for laparoscopic total mesorectal excision with an emphasis on autonomic nerve preservation. Google drive link- https://drive.google.com/file/d/10A84J7XQpV4SHqHJuLymP7vdUVJXKMdV/view?usp=drive_web You tube link- https://youtu.be/YwkjzsP4LNY wetransfer link- https://we.tl/t-XxX6UElgVC.