Autonomic nerve-preserving laparoscopic total mesorectal excision in a male patient based on a new anatomical concept
Epublication WebSurg.com, Sep 2010;10(09). URL: http://websurg.com/doi/vd01en3034
Dr. Kinugasa proposed the new concept of surgical anatomy in the pelvis. In his concept, the pre-hypogastric nerve fascia is defined as a fibrous membrane, which covers the superior hypogastric nerve plexus, the hypogastric nerves and the pelvic nerve plexus. In this video, we present our procedure of laparoscopic Total Mesorectal Excision (TME) in a male patient, focusing on the relationship of the hypogastric nerve fascia, the Denonvilliers’ fascia and the nervous system in the pelvis. The technical characteristics of this procedure are as follows: sharp dissection with electrocautery through the entire procedure, posterior and lateral dissection along the pre-hypogastric nerve fascia, anterior dissection behind the Denonvilliers’ fascia (DVF), and unroofing of neurovascular bundles by the assistant in order to recognize and dissect the lowest part of the mesorectum in the antero-lateral corner of the pelvis.