Presentation Information
[E1-6]Preservation of most nerves in the Denonvilliers' fascia during laparoscopic total mesorectal excision for middle rectal cancer-A video vignette.
Yao Zengwu, Yifei Zhang, Jinchen Hu (Yantai Yuhuangding hospital)
Rectal cancer is a global disease, and surgical resection is the most effective method for its treatment. Total mesorectal excision as the gold standard surgery for rectal cancer was first proposed by professor Heald in 1982, and it significantly reduced the probability of tumour recurrence after surgery . However, some studies have shown that sexual and urinary functions, which are considered closely related to the pelvic autonomic nerves, deteriorate to varying degrees after surgery . Division of the Denonvilliers’ fascia can damage the inferior hypogastric plexus and efferent pathways. However, the method of protecting the Denonvilliers’ fascia and ensuring the integrity of total mesorectal excision is a difficult point. Especially in some patients receiving neoadjuvant radiotherapy and chemotherapy, the anatomical layer is not very clear. Laparoscopic surgery allows for better visualization of autonomic nerves, and therefore, more precise dissection and preservation .
There are different surgical approaches to protect the Denonvilliers’ fascia. This video demonstrates in a 56-year old man with low rectal cancer, laparoscopic radical rectal resection after preoperative neoadjuvant chemoradiotherapy. We incise the peritoneum 1 cm above the peritoneal reflection, and then cut it about 0.5 cm from the cranial side after complete exposure of the Denonvilliers’ fascia. This approach ensures the integrity of anterior proper fascia of rectum and protects most of the nerves in the Denonvilliers’ fascia. The patient was followed-up for 2 years. Sexual and urinary function did not decrease significantly, and the tumour did not recur.
There are different surgical approaches to protect the Denonvilliers’ fascia. This video demonstrates in a 56-year old man with low rectal cancer, laparoscopic radical rectal resection after preoperative neoadjuvant chemoradiotherapy. We incise the peritoneum 1 cm above the peritoneal reflection, and then cut it about 0.5 cm from the cranial side after complete exposure of the Denonvilliers’ fascia. This approach ensures the integrity of anterior proper fascia of rectum and protects most of the nerves in the Denonvilliers’ fascia. The patient was followed-up for 2 years. Sexual and urinary function did not decrease significantly, and the tumour did not recur.