Total mesorectal excision (TME) is a relatively new modification of the standard procedure of LAR. The technique was first described by Heald and Ryall  and became a widely accepted surgical standard in the treatment of cancer of the rectum. The principle of the procedure involves complete removal of the mesorectum and the mesentery containing the inferior mesenteric artery and vein. The method combines what seems impossible: oncological radicality and preservation of pelvic autonomic nerves. The key step of the procedure is the identification and consequent preservation of the pre-aortic superior hypogastric plexus as well as laterally located hypogastric nerves and sacral splanchnic nerves forming inferior hypogastric plexus on both sides of the pelvic wall.
The introduction of TME together with a high lig-ation of the inferior mesenteric artery and adequate distal margins of safety has led to a significant reduction in local recurrence rates as well as a reduction in bladder and sexual function impairment .
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