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Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
The anatomic basis of total mesorectal excision
Moubin Lin1, Weiguo Chen, Liang Huang
1Department of Surgery, RuiJin Hospital, Medical College of Shanghai, Jiao Tong University, China. yindalu@yahoo.com.cn
American Journal of Surgery
|April 14, 2010
Summary
Clarifying surgical planes for total mesorectal excision (TME) in rectal cancer surgery is crucial. This study identifies key fascial layers and ligaments to guide accurate dissection, improving TME outcomes.
Area of Science:
- Anatomy
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Total mesorectal excision (TME) is the standard for rectal cancer.
- Current anatomical descriptions for TME are unclear and contradictory.
- Accurate delimitation of the mesorectum and surgical planes is needed.
Purpose of the Study:
- To clarify mesorectal boundaries.
- To identify anatomical landmarks for correct surgical planes in TME.
- To improve the precision of rectal cancer surgery.
Main Methods:
- Performed cadaveric dissections on 32 pelvises.
- Examined pelvic fasciae and their relationship to the rectum.
- Investigated fascial envelopes and their separation planes.
Main Results:
- Identified three pelvic fasciae: visceral, vesicohypogastric, and parietal.
- The lateral rectal ligament connects the rectum to the visceral fascia, not the pelvic sidewall.
- Two distinct fascial envelopes surround the rectum; pelvic plexus is difficult to separate from visceral fascia.
Conclusions:
- Autonomic nerves and lateral rectal ligament serve as landmarks for dissection planes.
- Posterior dissection should occur between visceral and parietal fasciae.
- Anterolateral dissection should occur between vesicohypogastric and parietal fasciae.
