Study of Applied anatomy of Laparoscopic Total Mesorectal Excision(LTME) for Rectal Cancer

Objective To provide anatomic foundation for laparoscopic total mesorectal excision(LTME) for rectal cancer.Methods Ten adult corpses fixed by 10% formalin.Twenty-eight cases of patients received LTME.The special structure of fasciae and lacuna around rectum were observed and measured.The anatomy closely related with operation was analyzed.Results ①The middle and superior segments of mesorectum are thicker and loosely connect with rectum,and have fibrous bands inserting in rectal wall;The inferior segment gradually becomes thinner to 2.2±1.1cm and connects tightly with muscle lamina of rectum.The length of this part of the mesorectum is 1.58±0.46cm.②Denonvilliers fascia is thin and compact.Its thinnest part is 1.3±0.6mm.③The Superior hypogastric plexus adheres to the back of inferior mesenteric vessels.There are no obvious branches of autonomic nerve in the loose space between visceral and parietal fascia of the direct back of the rectum.④The average operation time was 156min(126～235min),the intraoperative blood loss was 59ml(60～350ml).Postoperative follow-up for 2～39 months(mean,16months) found no local recurrence.Conclusions The mesorectum and Denonvilliers fascia are independent structures wrapping rectum.The mesorectum can be completely dissociated through sharp separating along sacral space and two sidewalls of rectum.Mastering the anatomical characteristics of laparoscopic rectum surgery can make us reduce the operative mistakes and complications.