The patient is in such a position that the lesion should be on the bottom of the operating field. This is usually the prone lithotomy position, but also on the left or right side or in the jack knife position if the lesion is ventral. Rigid rectoscopy must be performed to determine the position of the patient on the operating table.
An intraluminal ultrasound examination should be performed pre-operatively in all patients. If there are suspicious lymph nodes, TEM is indicated only as a palliative procedure.
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