*2.4.1 Anococcygeal ligaments*

The anococcygeal ligament is a fibrous membrane, which extends between the coccyx and the margin of the anal canal. In an anatomical study, the anococcygeal

#### **Figure 8.**

*Anatomy of the pelvic floor. (a) Inferior view. The levator ani muscle consists of pubococcygeus, iliococcygeus, and puborectalis muscle [21]. (b) Pelvic floor muscles and anal sphincter complex [20].*

**Figure 9.**

*Levator ani muscles and intersphincteric space. (a) Puborectalis and pubococcygeus muscle. (b) Intersphincteric space between rectum and puborectalis muscle.*

ligament was divided into two layers. The ventral layer of the ligament was loose and rich in small and fragile vessels and extended from the presacral fascia to the conjoint longitudinal muscle layer of the anal canal. The dorsal layer of the ligament was thin and dense and extended between the coccyx and external anal sphincter (**Figure 10**) [28]. To fully mobilize the rectum from the pelvic floor at the final stage of total mesorectal excision, the anococcygeal ligament must be divided. If the anococcygeal ligament cannot be seen in the final step, it can be visualized after the mesorectum is completely mobilized from the pelvic floor.
