 Today, we will be talking about the surgical anatomy for sigmoid colectomy for cancers of the sigmoid colon. D3 lymphoenectomy sparing the IMA helps us in retaining the blood supply to the distal as well as the proximal colon as well as the distal rectum and also at the same time doing the D3 lymph node dissection that is removing the lymph nodes at the level of the inferior mesentric artery. Hence, central D3 lymphoenectomy is feasible even after sparing the inferior mesentric artery and the superior rectal artery. The first step is as usual as we perform in a low anterior dissection is to mobilize the lower rectum by lifting the sigmoid colon up and by doing so we can also see the lifting up of the inferior mesentric artery. Just the same dissection is to cut the peritoneum, the visceral peritoneum adjacent to the inferior mesentric artery and try to locate the holy plane of yield. This part of dissection has already been shown in our YouTube channel by the surgical anatomy of low anterior dissection. Presently what we are doing is we are going distally from the inferior mesentric artery towards the promontory and trying to find out the plane of yield that is the holy plane also the avascular plane the plane of the fibrophary tissue. Now you can see the loose areolar fibrophary tissue coming up and the whole of the dissection is done by monopolar cotree. It is important to understand that this plane is very well seen right below the promontory. Now by the yellow arrow we can see the left superior hypogastric plexus of nerve has been lifted up because it gives its fibres to the rectum and the uterus in cases of females. The posterior dissection the posterior to the rectum and the lateral peritoneum was done. Now we go to the main dissection of the sigmoid colon or the sigmoidal branches. Now we can see by the yellow arrow the superior hypogastric plexus of nerves coalescing at the level of the arch of the iota. The dissection here is done using a bipolar or an energy source by which the lateral thermal spread is reduced. The inferior mesentric artery is tried to be isolated from all the fibrophary tissue enclosing it from the dorsal as well as the ventral. Here the central lymphatic lymph node dissection is being performed at the level of the root of the iota or the root or root of the inferior mesentric artery as shown by the red arrow. Now all the fibrophatic tissue and the central compartment of the lymph nodes that is the d3 lymph nodes for the sigmoid colon at the root of the mesentry of the sigmoid colon that is the origin of the inferior mesentric artery is taken slowly and steadily. All this fibrophatic tissue is cleared up from both ventral and dorsal side. The IMA is traced distally till it divides into the superior rectal artery and the terminal sigmoid branches that is the sigmoidal arteries. Here the variation is into three different types we will be seeing in a while. Now the dissection is being performed distally along the inferior mesentric artery slowly and steadily. The superior rectal artery is identified and all the fibrophatic tissue is swept from the inferior mesentric artery origin that is at the level of the iota and now it has been taken up approximately towards the sigmoidal branches. Now we are trying to create a plane between the sigmoidal artery branches and the superior rectal artery below is the superior rectal artery which goes below and supplies the upper part of the rectum and the middle part of the rectum and above is the sigmoidal branches which take off above and supply the sigmoidal sigmoid colon. The reason of preserving the inferior mesentric artery and the superior rectal artery is that while performing a sigmoid colactomy sometimes the inferior rectal artery and the middle rectal artery supply is not enough for the distal donut or the distal anastomosis or the integrity vascular integrity of the distal colon or the distal rectum. Now you can see that we have isolated the superior rectal branches above and we have created a window. Just to review the vascular anatomy preserving the inferior mesentric artery, we can see the iota below the inferior mesentric artery taking off from the iota. The left colic artery is also identified and all that fibrophatic tissue along with the lymph nodes are dissected from the root of mesentry of the sigmoid colon, also the left colic artery branches, the sigmoidal artery and also the superior rectal artery. There are total three variations in arterial supply type one is the most commonest wherein two or three branches are rising between the takeoff of the left colic artery and the superior rectal artery. Likely even in this case the sigmoidal branches were taking off between the LCA and the superior rectal artery as was shown to you. The most rare of the combinations is where the sigmoidal artery branches take off from the left colic artery hence it is important to identify the left colic artery as well. Now here we have looped the sigmoidal artery and we are just going to selectively clip only the sigmoidal artery branches preserving the superior rectal artery that enables the blood supply to the mid and the inferior rectum, lower rectum and helps a good blood supply which ensures a good anastomosis as well as the left colic artery is preserved along with the inferior mesentric artery which also assures us for the proximal vascular integrity of the proximal colon or the descending colon which is going to get anastomosed with the proximal or the upper rectum. By performing an IMA preserving D3 lymph nectomy we have two solutions at hand one a good lymph nodal clearance that is the Japanese standard and two a good anastomotic integrity. Thank you very much.