Anterior Dissection

The skin clamps are pulled anteriorly and the anterior perineal incision is developed in the anterior decussating fibres of the external sphincter down to the superficial and deep transverse perineal muscles. The abdominal operator passes the umbilical tape tied to the proximal rectosigmoid through the posterior dissection plane to the perineal operator who pulls the mobilised rectum and uses it for counter traction to facilitate the remainder of anterior dissection. The transverse perineal muscles are retracted anteriorly. The abdominal operator protects the prostate, seminal vesicles and urethra while the per-ineal surgeon follows the median raphe and puborec-tal muscle. Remaining tissues are divided with elec-trocautery with attention directed to avoid injury to the prostatic capsule or urethra, which is defined by the palpable bladder catheter. The specimen is thus resected en bloc. Any bleeding points are ligated or cauterised.

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