A 50-year-old female presented with intermittent rectal bleeding and discomfort.

Physical examination showed a 3-4cm rectal mass within the anterior quadrant, 2 cm cephalad to the dentate line. Rectal ultrasound showed a UT3N0 lesion.

Mobilization of the sigmoid and left colon, and splenic flexure is performed In a lateral to medial fashion, and pelvic dissection to the levators. Individual high ligation of the inferior mesenteric artery and vein is accomplished.

Following complete laparoscopic mobilization of the left colorectum, the surgeon and first assistant stand between the patient's legs. The anus is effaced with a retractor. A circumferential full-thickness incision is made at the dentate line and the peritoneal cavity is penetrated. The mobilized rectum, sigmoid, and left colon are delivered through the perineal incision. The left colon is extracorporeally transected with a linear cutter to reach the anus in a tension-free manner. A 5 cm colonic J-pouch is created and reduced into the pelvis; a circumferential hand-sewn pouch anal anastomosis is performed. The procedure is completed by laparoscopic creation of a diverting loop ileostomy.

This video describes laparoscopic low anterior resection, transanal mucosectomy, with transperineal construction of a colonic J pouch and handsewn anastomosis.