Total mesorectal excision for rectal cancer with emphasis on pelvic autonomic nerve preservation: Expert technical tips for robotic surgery

Kim, Nam Kyu; Kim, Young Wan; Cho, Min Soo

doi:10.1016/j.suronc.2015.06.012

Cited by 68 publications

(49 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Urogenital function is one of the most important aspects of quality of life and rectal cancer may have adverse effects on it[5,9-13]. Although urogenital dysfunction is considered to be multifactorial, intra-operative damage to the pelvic autonomic nerves is the primary cause[14-16].…”

Section: Introductionmentioning

confidence: 99%

“…Although urogenital dysfunction is considered to be multifactorial, intra-operative damage to the pelvic autonomic nerves is the primary cause[14-16]. This is mainly due to the close proximity of the mesorectum to the autonomic nerves, and the difficulty in identifying such small structures such as the autonomic nerves in a narrow operative space such as the pelvis[13,17]. Damage to the sympathetic nerves results in urinary incontinence, ejaculation disorders in men and decreased orgasmic intensity in women[13,18].…”

Section: Introductionmentioning

confidence: 99%

“…This is mainly due to the close proximity of the mesorectum to the autonomic nerves, and the difficulty in identifying such small structures such as the autonomic nerves in a narrow operative space such as the pelvis[13,17]. Damage to the sympathetic nerves results in urinary incontinence, ejaculation disorders in men and decreased orgasmic intensity in women[13,18]. Damage to the parasympathetic nerves leads to a lack of detrusor muscle function and subsequent voiding disorder, as well as erectile problems and lubrication dysfunction in men and women respectively[13,18].…”

Section: Introductionmentioning

confidence: 99%

“…Damage to the sympathetic nerves results in urinary incontinence, ejaculation disorders in men and decreased orgasmic intensity in women[13,18]. Damage to the parasympathetic nerves leads to a lack of detrusor muscle function and subsequent voiding disorder, as well as erectile problems and lubrication dysfunction in men and women respectively[13,18]. These are significant post-operative and life changing events that jeopardise patients quality of life[9].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery

Panteleimonitis

Ahmed

Harper

et al. 2016

WJGS

View full text Add to dashboard Cite

AIMTo analyses the current literature regarding the urogenital functional outcomes of patients receiving robotic rectal cancer surgery.METHODSA comprehensive literature search of electronic databases was performed in October 2015. The following search terms were applied: “rectal cancer” or “colorectal cancer” and robot* or “da Vinci” and sexual or urolog* or urinary or erect* or ejaculat* or impot* or incontinence. All original studies examining the urological and/or sexual outcomes of male and/or female patients receiving robotic rectal cancer surgery were included. Reference lists of all retrieved articles were manually searched for further relevant articles. Abstracts were independently searched by two authors.RESULTSFifteen original studies fulfilled the inclusion criteria. A total of 1338 patients were included; 818 received robotic, 498 laparoscopic and 22 open rectal cancer surgery. Only 726 (54%) patients had their urogenital function assessed via means of validated functional questionnaires. From the included studies, three found that robotic rectal cancer surgery leads to quicker recovery of male urological function and five of male sexual function as compared to laparoscopic surgery. It is unclear whether robotic surgery offers favourable urogenital outcomes in the long run for males. In female patients only two studies assessed urological and three sexual function independently to that of males. In these studies there was no difference identified between patients receiving robotic and laparoscopic rectal cancer surgery. However, in females the presented evidence was very limited making it impossible to draw any substantial conclusions.CONCLUSIONThere seems to be a trend towards earlier recovery of male urogenital function following robotic surgery. To evaluate this further, larger well designed studies are required.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery

Panteleimonitis

Ahmed

Harper

et al. 2016

WJGS

View full text Add to dashboard Cite

show abstract

“…In spite of surgical technical evolution and attention to preservation of pelvic nerves, many patients develop severe urinary, sexual and intestinal disturbances following ARR [6][7][8][9] . The group of functional alterations of intestine following ARR is known as low anterior resection syndrome -LARS 10,11 .…”

Section: Introductionmentioning

confidence: 99%

Aspectos fisiopatológicos da síndrome pós-ressecção anterior do reto para o tratamento de câncer retal

Buzatti

Petroianu

2017

Rev. Col. Bras. Cir.

View full text Add to dashboard Cite

RESUMO O número de pacientes com distúrbios funcionais intestinais em decorrência das operações para o tratamento do câncer retal tem aumentado durantes as últimas décadas. Alterações anatômicas e funcionais após a retirada do reto provocam aumento da frequência evacuatória, urgência evacuatória, evacuações múltiplas e incontinência para fezes e flatos, caracterizando a síndrome da ressecção anterior baixa ou LARS - "low anterior resection syndrome". Este artigo apresenta uma revisão geral do tema, com ênfase para conceitos atuais e aspectos fisiopatológicos de distúrbios funcionais do intestino após o tratamento cirúrgico do câncer retal. É fundamental que o cirurgião compreenda esses mecanismos, para melhor abordagem dos pacientes e restabelecimento da sua qualidade de vida.

show abstract

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

View full text Add to dashboard Cite

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.

show abstract

Total mesorectal excision for rectal cancer with emphasis on pelvic autonomic nerve preservation: Expert technical tips for robotic surgery

Cited by 68 publications

References 43 publications

Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery

Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery

Aspectos fisiopatológicos da síndrome pós-ressecção anterior do reto para o tratamento de câncer retal

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

Contact Info

Product

Resources

About