Introduction: The laparoscope reaches deep into the narrow pelvis that provides the lapenhanced surgical anatomy clearly. This understanding of precise anatomy allows the sharp and bloodless dissection for total mesorectal excision (TME). This explains laparoscopic procedures for TME, focusing on the sharp dissection in the pelvis with only electrocautery.

Methods: Sixty-four patients with lower rectal cancer underwent laparoscopic TME at our institution for 18 months. The dissection is commenced with posterior mobilization. The exposure of wide dissection of pelvic floor and the levator ani muscle expedites the following lateral dissection between the proper rectal fascia and nerves, the combination of the pelvic nerves and the neurovascular bundle (NVB). This reaches the lateral edges of Denonvilliere's fascia (DVF). The anterior dissection plane is placed in front of DVF that must be divided at the level of the base of prostate, because DVF fuses with the prostate capsule. The dissection continues between the anterior proper rectal fascia and the prostate capsule for completion. Obtaining a good surgical view with adequate tensions in dissecting plane by deliberate and coordinated hands of the assistant is important to maintain the continuous sharp dissection.

Results: No cases were converted to open surgery due to the technical difficulty or uncontrolled bleeding. The average operation time and the blood loss for the low anterior resection were 258min and 74g respectively.

Conclusion: Laparoscopic TME can be done safely and smoothly with only electrocautery. The importance is having a solid understanding of the lap-enhanced surgical anatomy for sharp dissection with only electrocautery.