Laparoscopic en bloc total mesorectal excision post chemoradiotherapy - a video vignette.

The role of laparoscopy in rectal surgery is recognised as an important development in recent years with large multicentre trials demonstrating the safety and feasibility of this approach (1–3). However, total mesorectal excision (TME) surgery in locally advanced rectal cancers remains challenging, often resulting in the adoption of an open approach by the surgical community in such patients. In this operative video we demonstrate a laparoscopic TME on a 72-year-old male patient with body mass index (BMI) 30, with locally advanced low rectal cancer (T4b anterior rectal cancer) who received long course neoadjuvant chemoradiotherapy. Surgery was performed at 12 weeks post treatment. The tumour was involving the left seminal vesicle, therefore an en bloc resection of the seminal vesicle was performed to achieve R0 resection. A standardised approach as previously described for laparoscopic TME was employed during this procedure (4). This article is protected by copyright. All rights reserved.