Erschienen in:
23.10.2020 | Video Forum
Fascial space priority approach for the management of the lateral ligaments in laparoscopic total mesorectal excision of the rectum
verfasst von:
Y. Sun, Z. C. Zhang, Y. D. Zhou, P. Li, Q. S. Zeng, X. P. Zhang
Erschienen in:
Techniques in Coloproctology
|
Ausgabe 4/2021
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Excerpt
Currently, nerve-sparing total mesorectal excision (TME) surgery is the most popular surgical procedure for lower rectal cancer. The posterior rectal space and anterior rectal space are widely recognized in TME surgery, but there is still controversy regarding the lateral rectal space and the lateral rectal ligaments [
1]. Historically, surgeons believed that the lateral ligament of the rectum was where the neurovascular bundle and lymphatics entered the rectum, was located laterally to the mid-rectum, and needed to be sufficiently separated and dissected during the operation. However, anatomists argued that there is no traditional ligamentous structure, it is the fusion of parietal and visceral fascia laterally to the rectum and it is hard to identify in a fresh cadaver. The common ground is that it is a compact structure lateral to the rectum, hard to identify, in close relation to the hypogastric nerves and pelvic plexus [
2,
3]. Thus, it is an important part of nerve sparing TME surgery and a challenging one. While recognizing the importance of the lateral ligaments, surgeons do not yet have an effective and universal method for the intraoperative management of these structures. …