Fig. 3

a Dissection the presacral space below the superior rectal artery (SRA) approached from the left side across the midline to the right side attentively protected hypogastric nerves while using a bipolar electrosurgical device. b Identification of the relationship between left colic artery/IMV to the IMA and SRA and the branch of the arteriae sigmoideae. c Tracing this vascular bundle from the origin of the IMA to the rectum segment approximately 4–5 cm below the inferior border of the tumor. d Ligation of arteriae sigmoideae and vascular branch from SRA. e Ligation of arteriae sigmoideae and preserving left colonic vasculature. f Excision of the mesorectum just underneath the rectal wall about 3–5 cm and avoiding injury to the rectal wall and SRA. g TSME preserving left colic artery and superior rectal artery