Anatomy and technical points of pelvic autonomic nerves preservation in laparoscopic radical resection of rectal cancer

Abstract

Total mesorectal excision (TME) is considered as the standard surgical procedure for rectal cancer worldwide. With the popularization and cognition of laparoscopic technology and TME procedure, the pelvic autonomic nerves preservation (PANP) in proctectomy is valued gradually. Based on the author′s experience and combined with published literatures, this paper introduces the new understanding and technological progress of preserving PANP. In the authors′ opinion, there are six areas which are easily injured in the TME procedure: inferior mesorectal plexus at the root of inferior mesorectal artery, superior hypogastric plexus and the proximal part of hypogastric plexus, proximal part of anterior branches of pelvic plexus, main trunk of posterior branches of pelvic plexus, terminal part of posterior branches of pelvic plexus, pelvic splanchnic nerves and neurovascular bundle (NVB). Familiarity with the anatomy of pelvic fascia and autonomic nerves, development of TME plane dominated and pelvic autonomic nerves guided precise radical proctectomy play an important role in promoting the quality of operation and protecting the function of organ. Key words: Rectal neoplasms; Digestive system surgical procedures; Pelvic autonomic; Nerves preservation