How to Optimize Autonomic Nerve Preservation in Total Mesorectal Excision: Clinical Topography and Morphology of Pelvic Nerves and Fasciae

Abstract

The highest risk for pelvic nerve damage-apart from lesions of the superior hypogastric plexus itself-is anterolaterally of the rectum where the neurovascular bundle releases from the pelvic sidewall. Careful dissection helps to identify and protect these nerve structures. The retroprostatic Denonvilliers' fascia contains no important nerve structures.

Selective Pelvic Autonomic Nerve Stimulation with Simultaneous Intraoperative Monitoring of Internal Anal Sphincter and Bladder Innervation

“…The variability of the observed response signals with regard to the stimulation site in the present study might be attributed to the complexity of the intrapelvic neuroanatomy and topography, in particular to the organ-specific functional architecture of the primary and secondary autonomic plexus [22,23,24]. …”

Anatomy of the Pelvis

“…It is really interesting that the fi rst surgeons who described erectile dysfunction after pelvic surgery were general surgeons that performed surgery to the rectum [ 17 ]. Surgeons performing resections of the rectum are following the Denonvilliers' fascia for the ventral dissection in order to avoid damaging the urinary and erectile function [ 18 ]. Walsh and Donker were the fi rst to describe the NVBs and described the surgical technique to preserve these anatomical structures [ 19 ].…”

Surgical and pathomorphological results of total mesorectumectomy by using waterjet dissection technique in patients with rectal cancer

“…Поиск возможностей сохранения вегетативных нервных сплетений при проведении операций у паци-ентов с раком прямой кишки является объектом при-стального внимания многих авторов последние не-сколько лет [15][16][17]. В мировой литературе имеется информация (в том числе экспериментальные данные) о меньшей степени латерального термического повре-ждения вегетативных нервов при мобилизации прямой кишки с применением гармонического скальпеля по сравнению с использованием монополярного коагу-лятора [18,19].…”