Total mesorectal excision and preservation of the pelvic autonomic nerves: Technical tips and pitfall

To obtain relevant oncologic outcome and good functional outcome after rectal cancer surgery, total mesorectal excision (TME) with pelvic autonomic nerve (PAN) preservation is essential. Adequate TME with intact mesorectal fascia is very important to achieve clearance of lymphatics; also, avoiding nerve injuries including superior and inferior hypogastric nerves and neurovascular bundles in the pelvis is essential for good postoperative voiding and sexual function. In this context, this chapter is highlighting on fascial anatomy for TME and autonomic nerve structures. On the basis of the anatomy, technical tips for TME with PAN preservation are introduced by the author. This review of anatomy for TME and technical issues for preserving PAN will provide you an insight of desirable TME.