Denonvilliers’ fascia in men: a sheet plastination and confocal microscopy study of the prerectal space and the presence of an optimal anterior plane when mobilizing the rectum for cancer

Abstract

Aim The aim of this study was to investigate the detailed, in situ, morphology of Denonvilliers’ fascia (DVF) in cadavers using sheet plastination and confocal microscopy and to review and describe the optimal anterior plane for mobilization of the distal rectum. Method Six male cadavers (age range 46–87 years) were prepared as six sets of transverse (× 2), coronal (× 1) and sagittal (× 3) plastinated sections which were examined under a confocal laser scanning microscope. Results In this study a consistent space between the anterior rectal wall and the posterior surface of the prostate and seminal vesicles above the level of the perineal body was termed the prerectal space. Within that prerectal space we identified fibres which take their origin from the external urethral sphincter (EUS), together with others from the longitudinal rectal muscle (LRM) and the connective tissue sheaths of neurovascular bundles. Neither the EUS‐ nor the LRM‐originated fibres were continuous with the endopelvic fascia; they were interposed laterally and cranially by multiple neurovascular bundles. Further, our results suggest that the peritoneum does not descend deep within the prerectal space. Conclusion This study reveals the undisturbed, in situ, structural detail of membrane‐like structures in the prerectal space and confirms that the optimal plane for anterolateral mobilization of the rectum is posterior to the multilayered Denonvilliers’ fascia.

Fibrous configuration of the fascia iliaca compartment: An epoxy sheet plastination and confocal microscopy study

“…The lateral part of the fascia lata overlapped the sartorius and was formed by 2-3 curtain strip-like ligaments which were termed "the iliolata ligaments" in this study ( Fig. 2A,B) 18 . The iliolata ligaments Fascia-like structures underneath the fascia lata.…”

Use the Peritoneal Reflection to Identify the Correct Avascular Plane Posterior to Denonvilliers' Fascia

“…Furthermore, from a technical point of view, we would suggest that a key issue in this debate remains as to how best to identify the correct plane of mobilization at operation whether the procedure be performed by open surgery or by a combined laparoscopic and robotic approach and especially when attempting to resect the rectum by a transanal TME technique. A recent study revealed the precise nature, fine architecture, and localization of membrane-like structures present within the prerectal space and confirmed that the optimal plane for the anterolateral mobilization of the rectum is posterior to the multilayered DVF (Xu et al, 2018). Thus, we agree with the authors' description that to identify the correct anterior plane, the dissection must commence precisely in line with the peritoneal reflection from the back of the prostate or vagina to ensure identifying the correct avascular plane posterior to DVF (Bokey, 2013).…”

Three-Dimensional Approaches in Histopathological Tissue Clearing System

“…More recently, plastination has been introduced for long term preservation of tissues, organs, systems and whole body by replacement of water and lipid with plastic monomers which impart transparency to the objects [17]. Plastination was rather suitable for establishing educational materials than used for biomedical research in histopathology due to its penetrating limitation less than 3 mm of thickness after plastic polymerization [18][19][20] [70,71] Abbreviations: FLIM, fluorescence lifetime imaging; ADOTA, azadioxatriangulenium; LED, light emitting diode. [38].…”