Anatomical considerations for transanal minimal-invasive surgery: the caudal to cephalic approach

Publication

Anatomical considerations for transanal minimal-invasive surgery: the caudal to cephalic approach

Journal Paper/Review - Feb 1, 2015

Aigner Felix, Morales-Conde Salvador, Zorron Ricardo, Sileri Pierpaolo, Boni Luigi, de Graaf Eelco Jr, Scherer Roland, Shamiyeh Andreas, Klaus Alexander, Tse Cyrus, Brunner Walter, Panis Yves, Herbst Friedrich, Hörmann Romed, Fritsch Helga, Pratschke Johann, D'Hoore André, Brenner Erich, Williams Norman, Biebl Matthias, The TAMIS TME collaboration group, Weiss Helmut, Mittermair Reinhard

Citation

Aigner F, Morales-Conde S, Zorron R, Sileri P, Boni L, de Graaf E, Scherer R, Shamiyeh A, Klaus A, Tse C, Brunner W, Panis Y, Herbst F, Hörmann R, Fritsch H, Pratschke J, D'Hoore A, Brenner E, Williams N, Biebl M, The TAMIS TME collaboration group, Weiss H, Mittermair R. Anatomical considerations for transanal minimal-invasive surgery: the caudal to cephalic approach. Colorectal Dis 2015; 17:O47-O53.

Type

Journal Paper/Review (English)

Journal

Colorectal Dis 2015; 17

Publication Date

Feb 1, 2015

Issn Electronic

1463-1318

Pages

O47-O53

Brief description/objective

AIM
Nerve sparing surgery during laparoscopic rectal mobilization is still limited by anatomical constraints such as obesity, the narrowness of the male pelvis or an ultra low rectal cancer or all of these. The transanal approach for total mesorectal excision has overcome the shortcomings of limited access to the rectal "no-man's land" close to the pelvic floor. The aim of this anatomical study was to define a roadmap of anatomical landmarks for the caudal to cephalic approach so as to standardize nerve sparing rectal mobilization procedures.

METHOD
Macroscopic dissections of the pelvis in a caudal to cephalic direction were performed in eight alcohol-glycerol embalmed cadavers. A roadmap of anatomical landmarks was created at different levels of section to demonstrate the sites of nerve injury.

RESULTS
Extrinsic autonomic nerves to the urogenital organs and the internal sphincter muscle are closely adjacent to the lowest portion of the rectum above the pelvic diaphragm.

CONCLUSION
This anatomical guide for the pelvic surgeon should facilitate a safe and nerve-sparing dissection of the mesorectal plane with a meticulous overview of the lowest autonomic nerve fibres. New anatomical insights by a "caudal to cephalic" approach to the "no-man's land" should help overcome anatomical constraints of a narrow, obese and male pelvis during rectal mobilization procedures. This article is protected by copyright. All rights reserved.