In advanced low rectal cancer where the circumferential rectal margin is clearly involved, the autonomic nerves often cannot be preserved. Different techniques of autonomic nerve preservation have been described [1-8].
In this video we would like to show our approach to laparoscopic TME with AN1 autonomic nerve preservation [1]. The patient is a 59 years old female with a BMI 28. The symptomatology started with rectal bleeding and weight loss. The colonoscopy showed an adenocarcinoma of the lower rectum 5 cm from the anal verge. The CT and MRI images showed left-sided patholgical pelvic nodes, infiltrating the sacral nerves. The patient underwent chemoradiotherapy for 4 weeks. She was scheduled for a laparoscopic TME with AN1 autonomic nerve preservation using the cavitron ultrasonic surgical aspirator (CUSA®) for pelvic dissection [1,9]. This procedure was performed in the General and Oncologic Surgery Unit, “St. Giuseppe Moscati Hospital”, Avellino RESULTS: The operative time was 180 minutes. and the hospital stay was 5 days. The postoperative course was uneventful. At 6 months follow-up the patient did not report any functional pelvic disorders, recurrence, or distant metastases.
In Centers with high expertise in the treatment of advanced low rectal cancer the partial preservation of autonomic innervation is feasible with good oncological results and an acceptable quality of life.

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