Fig. 2

Operative views. a Transanal view. After dissecting the levator ani muscle, the anococcygeal ligament was explored. b Transabdominal (laparoscopic) view. After rendezvous of the transanal and transabdominal space, the residual rectum was dissected from the dorsal side to lateral side. The prostate was explored laparoscopically, and the layer between the prostate and the residual rectum was dissected with support from the transanal approach to avoid injuring the rectourethral muscle and the urethra. c Transabdominal (laparoscopic) view after resection of the residual rectum. Strong adhesion of the small intestine to the pelvic wall was observed, and the natural pelvic anatomy was unclear because of the history of multiple surgeries. d Schema of the intraoperative overview of the abdomen. During the operation, the end ileostomy was covered by gauze and plastic film. A drainage tube was inserted from the left lower incision, through which a port was inserted, to the pelvic cavity after the operation