解剖及内括约肌切除术（ISR）腹腔镜技术治疗低位直肠癌

                               
登录/注册后可看大图

The video shows the steps and anatomy of laparoscopic intersphincteric resection (ISR). Following mobilization of the left colon, nerve-preserving total mesorectal excision (TME) is conducted down to the pelvic floor. Pelvic plexus and neurovascular bundle are carefully preserved with the covering connective tissue. Entry into the anal canal starts from dissection between the pubococcygeal muscle and rectal wall, followed by division of the rectococcygeal muscle, then completed by precise dissection of intersphincteric plane which is inside of the puborectal muscle. Understanding this anatomy is mandatory for precise ISR. The dissected intersphincteric space is easily communicated by incision on the dentate line from the anus. The specimen is retrieved and hand-sewn anastomosis is completed.