How to find Denonvilliers’ fascia during laparoscopic TME

Excerpt

Total mesorectal excision (TME) has been performed widely for mid-low rectal cancer. Previous studies have suggested that optimal TME for rectal cancer is anterior to Denonvilliers’ fascia (DF), because there is usually no surgical plane posterior to DF [1]. The bilateral edges of DF are perilously close to the converging neurovascular bundles. To avert damage to the neurovascular bundles, the lateral edges of Denonvilliers’ fascia should be identified and preserved by a U-shaped cut. However, some studies revealed that during dissection anterior to DF, there was a great risk of intraoperative damage of neurovascular bundles resulting in postoperative urogenital dysfunction [2]. In a previous study, we showed that TME in laparoscopic resection for mid-low rectal cancer dissection posterior to DF permitted better preservation of urogenital function [3]. Therefore, we suggest that dissection anterior to DF in TME for rectal cancer should be reconsidered and we propose that in patients with early-stage (T1, T2) mid-low rectal cancer in the anterior wall, and in all patients with posterior rectal cancer dissection should be carried out posterior to DF to protect the pelvic nerves and prevent postoperative urogenital dysfunction. …