Abstract:

The anatomical significance and surgical dissection of Denonvilliers' fascia in laparoscopic and robotic total mesorectal excision        CHI Pan, WANG Xiao-jie. Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, China
Corresponding author: CHI Pan, E-mail: cp3169@163.com
Abstract    To dissect in the pre-rectal space is a technically difficult procedure during laparoscopic and robotic total mesorectal excision. With the further understanding of surgical membrane anatomy and the relationship between Denonvilliers' fascia and neurovascular bundles （NVB），surgeons can identify and protect the NVB during dissecting in the pre-rectal space without oncological compromise. The article introduces a surgical technique of an individual dissection of Denonvilliers' fascia. Firstly， entering the pre-Denonvilliers space by cutting the peritoneum at 1 cm anterior and cranial to the peritoneal reflection. Secondly， entering the post-Denonvilliers space by a U-shaped cut of the anterior lobe of Denonvilliers' fascia at the inner side of NVB， and at 0.5 cm away from the bottom of seminal vesicles for males or 5 cm below the peritoneal reflection for females.

Key words: laparoscopic, total mesorectal excision, Denonvilliers fascia, neurovascular bundles, membrane anatomy

摘要：

直肠前间隙的分离一直是机器人和腹腔镜全直肠系膜切除（TME）的难点。基于膜解剖原理，系统地认识Denonvilliers筋膜及血管神经束（NVB）的相关解剖，有助于外科医师在保证肿瘤根治的前提下，尽量保护相关自主神经。在行TME时，应行个体化的Denonvilliers筋膜部分切除。进行直肠前方分离时，应在腹膜反折上方1 cm弧形切开膜桥，进入Denonvilliers筋膜前间隙。此后男性在距两侧精囊腺底部0.5 cm，女性距腹膜反折约5 cm，相当于两侧NVB内侧，呈倒“U”形弧形切开离断Denonvilliers筋膜前叶，进入Denonvilliers筋膜后间隙，向下继续分离。

关键词: 腹腔镜, 全直肠系膜切除, Denonvilliers筋膜, 血管神经束, 膜解剖