Abstract:

Total mesorectal excision (TME) is now considered the gold standard for surgical treatment of middle/lower rectal cancers, which required sharp dissection under direct vision with the en bloc resection of the tumor along with mesorectum including fat tissue, neurovascular and lymph nodes covered by the rectal proper fascia.This coincidence with the theory of membrane anatomy which demands sharp separation of visceral and parietal fascia based on embryonic anatomy. Combining laparoscopic magnification and the 3D image with depth perception, applying membrane anatomy to rectal surgery could achieve a better understanding of the mesentery with more effective identification of the pelvic autonomic nerves. After peritoneal fusion fascia degenerates, the posterior space of rectum is filled with the loose connective tissue. Waldeyer’s fascia was observed in this space at the S4 level, originating from the presacral parietal fascia fusing with the rectal visceral fascia at the posterior aspect of the rectum. The Waldeyer’s fascia divides the retrorectal space into a superior and inferior compartments. The key structure of lateral rectum is lateral ligament, which is exactly the "port" of the proper fascia of rectum. The lateral ligament containing the middle rectal artery, the pelvic plexus rectal branch and the adipose tissue is surround by the proper fascia of the rectum. Denonvilliers’fascia is the product of peritoneal fusion, and the most important structure in front of the rectum. Preservation of Denonvilliers’ fascia during laparoscopic resection for mid-low rectal cancer have a good effect on protection of urinary and sexual functions of patients. Dissection behind the Wei’s line in the lowest level of peritoneal reflexcan enter into the back plane of Denonvilliers’fascia, and Denonvilliers’fascia could be preserved entirely, as well as the protection of postoperative urogenital function.

Key words: Rectal neoplasms, Laparoscopes, Mesentery, Total mesorectal excision, Membrane anatomy