A New Technique for Safe and Nerve Preserving Total Mesorectal Excision

Abstract

Summary Our purpose was to present a technique of pneumodissection applied with total mesorectal excision that ensured effective pelvic nerve preservation. Its detailed description emphasized the role of the proper definition of optimal dissection plane around the rectal cancer, the so-called ‘holy plane’ for total mesorectal excision. The study covered 28 rectal cancer patients at a mean age of 58±7.6 years (range 53 to 69 years). Rectal cancers were of TNM stages I-III and differentiation grades of G1-G3. Total mesorectal excision with pneumodissection between 2011 and 2016 was performed. Inflation of the pararectal space with CO2 improved visualization of the operative field between visceral and parietal fascia thus preserving plexus (pl.) vesicalis, pl. deferentialis, pl. prostaticus and pl. cavernosus penis. A fast and clean mesorectum mobilization was made without any damage to the visceral fascia, and total mesorectal excision was performed in the embryonal plane. Pl. hypogastricus superior in the region of the aortic bifurcation nervi (nn.) hypogastrici dextri et sinistri laterally to the rectum and pl. hypogastricus inferior were preserved, too. Encouraging postoperative results included pelvic nerve preservation and absence of complications. A broader application of the safe method of pneumodissection in open and laparoscopic rectal cancer surgery should be recommended.