Techniques of autonomic nerve preservation in laparoscopic radical resection for rectal cancer
10.3760/cma.j.issn.1671-0274.2015.06.003
- VernacularTitle:腹腔镜保留盆腔自主神经的直肠癌根治术技术要领
- Author:
Hongbo WEI
1
;
Zongheng ZHENG
Author Information
1. 中山大学附属第三医院胃肠外科
- Keywords:
Rectal neoplasms;
Autonomic nerve;
Laparoscopic;
Radical resection
- From:
Chinese Journal of Gastrointestinal Surgery
2015;(6):529-532
- CountryChina
- Language:Chinese
-
Abstract:
Pelvic autonomic nerve is a three-dimensional structure surrounding the rectum. There are several key points related to nerve injury during laparoscopic radical resection for rectal cancer. Hypogastric nerve has close relation with the upper and middle part of the rectum. Combined with S2-S4 pelvic splanchnic nerve, hypogastric nerve forms pelvic plexus. Incorrect operation in pelvic parietal peritoneum during dissection of upper rectum will lead to nerve injury. When performing dissection of inferior mesenteric artery, bilateral nerve tracts should be pushed to posterior abdominal wall and anterior fascia of the abdominal aorta should be well protected to avoid nerve injury. Pelvic plexus fibers located lateral to the rectum of pelvic floor, as well as neurovascular bundle closed to Denonvillier′s fascia, also have close relations with nerve injury. Dissection of either lateral or anterior wall of rectum should be performed behind the Denonvillier′s fascia and in front of the proper fascia of rectum. Sharp dissection should be performed closed to the mesorectum to protect branches of pelvic plexus.
