Total Mesorectal Excision—Does the Choice of Dissection Technique have an Impact on Pelvic Autonomic Nerve Preservation?

Kauff, Daniel W.; Kempski, Oliver; Huppert, Sabine; Koch, Klaus Peter; Hoffmann, K.; Lang, Hauke; Kneist, W.

doi:10.1007/s11605-012-1870-1

Cited by 16 publications

(6 citation statements)

References 17 publications

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“…However, the incidence of urogenital dysfunction remains common if the pelvic autonomic nerve is unprotected during TME. The introduction of TME with pelvic autonomic nerve preservation (PANP) enables optimal oncologic outcomes in addition to acceptable post‐operative anorectal and urogenital dysfunction (Havenga et al, ; Kauff et al, ; Shirouzu et al, ). Nevertheless, the incidence of pelvic organ dysfunction after TME remains as high as 8.0–42.9% (Havenga et al, ; Shirouzu et al, ).…”

Section: Discussionmentioning

confidence: 99%

Preservation of Denonvilliers' fascia for nerve‐sparing laparoscopic total mesorectal excision: A neuro‐histological study

et al. 2019

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Urogenital complications due to pelvic autonomic nerve damage frequently occur following rectal surgery. We investigated whether total mesorectal excision (TME) with preservation of the Denonvilliers' fascia (DVF) can effectively prevent the removal of pelvic autonomic nerves through microscopy. Twenty consecutive male patients with mid-low rectal cancer who received TME with preservation or resection of the Denonvilliers' fascia (P and R groups, respectively) were included. Serial transverse sections from surgical specimens were studied histologically. Nerve fibers at the surfaces of the mesorectum were counted. Clinical correlation between the amount of nerve fibers removed and post-operative sexual function was analyzed. Nerve fibers closely localized to the DVF in the R group displaying rich erectile activity (positive anti-nNOS immunostaining). At the anterior surface of the mesorectum, the mean numbers of nNOS-positive nerve fibers per specimen in the P group were significantly lower than the R group (3.0 AE 1.8 vs. 5.0 AE 2.3, P < 0.05). Compared to the R group, patients in the P group had higher IIEF scores and better erectile function at 3 and 6 months post-operatively. The DVF is a key risk zone for pelvic denervation during laparoscopic TME. Preservation of the DVF can prevent the removal of autonomic nerves and protect postoperative erectile function. Clin. Anat. 32:439-445, 2019.

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Section: Discussionmentioning

confidence: 99%

Preservation of Denonvilliers' fascia for nerve‐sparing laparoscopic total mesorectal excision: A neuro‐histological study

et al. 2019

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“…Surgical resection is the most effective treatment measure for curing patients with rectal cancer [2]. Despite a series of studies on rectal cancer surgery with pelvic autonomic nerve preservation, the rate of postoperative urogenital dysfunction in patients with rectal cancer, especially in men, remains high, seriously affecting the patient's postoperative quality of life [3][4][5]. In 1982, Heald et al [6] proposed the theory of total mesorectal excision (TME) as the gold standard surgery for rectal cancer.…”

Section: Introductionmentioning

confidence: 99%

Identification of the surgical indication line for the Denonvilliers’ fascia and its anatomy in patients with rectal cancer

Huang

Liu

Fang

et al. 2020

Cancer Communications

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Background The high rate of urogenital dysfunction after traditional total mesorectal excision (TME) has caused doubts among scholars on the standard fashion of dissection. We have proposed the necessity to preserve the Denonvilliers’ fascia in patients with rectal cancer. However, how to accurately locate the Denonvilliers’ fascia is unclear. This study aimed to explore anatomical features of the Denonvilliers’ fascia by comparing autopsy findings and observations of surgical videos so as to propose a dissection method for the preservation of pelvic autonomic nerves during rectal cancer surgery. Methods Five adult male cadaver specimens were dissected, and surgical videos of 135 patients who underwent TME for mid‐low rectal cancer between January 2009 and February 2019 were reviewed to identify and compare the structure of the Denonvilliers’ fascia. Results The monolayer structure of the Denonvilliers’ fascia was observed in 5 male cadaver specimens, and it was located between the rectum, the bottom of the bladder, the seminal vesicles, the vas deferens, and the prostate. The Denonvilliers’ fascia was originated from the rectovesical pouch (or rectum‐uterus pouch), down to fuse caudally with the rectourethral muscle at the apex of the prostate, and fused to the lateral ligaments on both sides. The fascia was thinner on the midline with a thickness of 1.06 ± 0.10 mm. The crown shape of the Denonvilliers’ fascia was slightly triangular, with a height of approximately 5.42 ± 0.16 cm at midline. Nerves were more densely distributed in front of the Denonvilliers’ fascia than behind, especially on both sides of it. Under laparoscopic view, the Denonvilliers’ fascia was originated at the lowest point of the rectovesical pouch (or rectum‐uterus pouch), with a thickened white line which was a good mark for identifying the Denonvilliers’ fascia. Conclusion Identification of the surgical indication line for the Denonvilliers’ fascia could help us identify the Denonvilliers’ fascia, and it would improve our ability to protect the pelvic autonomic function of patients undergoing TME for rectal cancer.

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“…Preservation of the pelvic autonomic nerve (PAN) in rectal cancer surgery is widely performed to maintain urinary and sexual functions [1][2][3][4][5][6][7][8]. Nerve-sparing total mesorectal excision has been shown to have advantages in terms of better prevention of urogenital dysfunctions [9].…”

Section: Introductionmentioning

confidence: 99%

Effect of intra‐operative autonomic nerve stimulation on pelvic nerve preservation during radical laparoscopic proctectomy

et al. 2015

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Total Mesorectal Excision—Does the Choice of Dissection Technique have an Impact on Pelvic Autonomic Nerve Preservation?

Abstract: Scissors, ultracision, and monopolar diathermy might have comparable nerve-sparing potentials and differed from waterjet.

Cited by 16 publications

References 17 publications

Preservation of Denonvilliers' fascia for nerve‐sparing laparoscopic total mesorectal excision: A neuro‐histological study

Preservation of Denonvilliers' fascia for nerve‐sparing laparoscopic total mesorectal excision: A neuro‐histological study

Identification of the surgical indication line for the Denonvilliers’ fascia and its anatomy in patients with rectal cancer

Effect of intra‐operative autonomic nerve stimulation on pelvic nerve preservation during radical laparoscopic proctectomy

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