The remaining description applies to the completion of a single-stage total proctocolectomy. As shown in Figure 15, the mesentery is divided adjacent to the rectosigmoid rather than up over the iliac artery bifurcation, as would be done in carcinoma. The peritoneum adjacent to the bowel is divided after identification of the ureters on either side, and the peritoneum in the pouch of Douglas between the rectum and bladder or cervix is incised. This flap is carefully elevated. This dissection along with that into the presacral space is facilitated by using lighted deep pelvic retractors, a focused headlight on the surgeon, and an extra-long insulated electrocautery tip. The dissection proceeds into the same presacral space as the mesorectal dissection, but the surgeon can stay closer to the rectum laterally and anteriorly, as this operation does not require the wide margins necessary for a malignancy. At this point, the rectum may be divided with a cutting linear stapler (GIA) or endoscopic reticulating GIA stapler or it may be transected between clamps (Figure 16). The distal stump is then oversewn (Figure 17). At this time, sharp dissection about the rectum should be carried out to free it as low as possible in order to lessen the blood loss during the subsequent perineal excision.