A 57-year-old woman underwent transanal endoscopic microsurgery (TEM) for T1 rectal cancer. Final histology demonstrated T2 invasion (Figure 1). A total mesorectal excision (TME) was recommended. Operation started in a prone-jacknife position performing partial TME from below (Figure 2, 3). The mobilized rectum (Figure 4) and rectal stump (Figure 5) were closed with purse-string sutures. A completion laparoscopic TME was performed with colonic J pouch anal stapled anastomosis. An intact rectal specimen was achieved (Figure 6).
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