Surgical Steps: Posterior Rectal Dissection

• Retract the sigmoid colon cephalad and to the left side using the Grasping Retractor.
• Dissect the mesorectum from the presacral fascia by pushing it anteriorly and identifying the presacral space.
• Dissect the presacral space from the right to left side along the avascular plane between the mesorectal fascia and the presacral fascia
• Identify the hypogastric nerves and, more distally, the pelvic nerve plexus to minimize potential for injury.
• Dissect small vessels by electrocautery to minimize bleeding into the presacral space. This helps to maintain the proper plane of dissection between fascia propria and presacral fascia to avoid injury to the rectal wall. It also allows better identification and avoidance of injury to small pelvic nerves and the sacral venous plexus.
• Continue dissection distally into the pelvis and open Waldeyer’s fascia (usually visible as a thickening of the presacral plane).
• Carry out dissection to the level of the pelvic floor using a blunt and sharp technique.

1. Initial Exposure
2. Primary Vascular Control
3. Medial to Lateral Mobilization of Sigmoid & Descending Colon
4. Splenic Flexure Mobilization
5. Rectal Dissection & Division
• Posterior Dissection
• Lateral Dissection
• Anterior Dissection
• Rectal Division