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Pelvic Autonomic Nerve Preservation during Total Mesorectal Excision (TME) from Werner Kneist

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Gastrointestinal Operations and Technical Variations
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Abstract

According to the German guideline for “Colorectal Cancer,” total mesorectal excision (TME) removes the cancer located at the central and lower thirds of the rectum and the pelvic floor while preserving the superior hypogastric plexus (SHP), the hypogastric nerves, and the inferior hypogastric plexus (IHP) (recommendation level A, level of evidence 1b, strong consensus). Intraoperative nerve damage is to be avoided to preserve postoperative quality of life with the premise of radical surgery. It is particularly necessary to preserve autonomously controlled urogenital and anorectal functions. Among other things, this presumes a fundamental understanding of current events on surgical topography, neuroanatomy, and neurophysiology.

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References

  1. Clausen N, Wolloscheck T, Konerding MA. How to optimize autonomic nerve preservation in total mesorectal excision: clinical topography and morphology of pelvic nerves and fasciae. World J Surg. 2008;32:1768–75.

    Article  PubMed  Google Scholar 

  2. Junginger T, Kneist W, Herrmann M. Die nervenerhaltende totale mesorektale Exzision bei Rektumkarzinom unter besonderer Berücksichtigung der chirurgischen Anatomie. Deutsche Gesellschaft für Chirurgie. Düsseldorf, Cologne: German Medical Science; 2006. Doc06dgch5816 (www.egms.de/de/meetings/dgch2006/06dgch740.shtml).

  3. Kauff DW, Kempski O, Huppert S, Koch KP, Hoffmann KP, Lang H, Kneist W. Total mesorectal excision – does the choice of dissection technique have an impact on pelvic autonomic nerve preservation? J Gastrointest Surg. 2012;16:1218–24.

    Article  PubMed  Google Scholar 

  4. Kneist W, Heintz A, Junginger T. Intraoperative identification and neurophysiologic parameters to verify pelvic autonomic nerve function during total mesorectal excision for rectal cancer. J Am Coll Surg. 2004;189:59–66.

    Article  Google Scholar 

  5. Kneist W, Heinz A, Wolf HK, Junginger T. Identification of pelvic autonomic nerves during partial and total mesorectal excision – influence parameters and significance for neurogenic bladder. Chirurg. 2004;75:276–83.

    Article  CAS  PubMed  Google Scholar 

  6. Kneist W, Kauff DW. Intraoperative neuromonitoring. In: Kramme R, Hoffmann KP, Pozos RS (Pub.) Handbook of medical technology. Heidelberg: Springer; 2011, p. 1043–57.

    Google Scholar 

  7. Kneist W, Kauff DW, Gockel I, Huppert S, Koch KP, Hoffmann KP, Lang H. TME with intraoperative assessment of internal anal sphincter innervation provides new insights into neurogenic incontinence. J Am Coll Surg. 2012;214:306–12.

    Article  PubMed  Google Scholar 

  8. Kneist W, Radner H, Knerr B, Junginger T. [Lateral mesorectal dissection – a risk for the inferior hypogastric plexus]. at: Ulrich B, Jauch KW, Bauer H (eds) Chirurgisches Forum 2004 für experimentelle und klinische Forschung. Forumband,33. Heidelberg: Springer; 2004, p. 227–9.

    Google Scholar 

  9. Kneist W, Rink AD, Kauff DW, Konerding MA, Lang H. Topography of the extrinsic internal anal sphincter nerve supply during laparoscopic-assisted TAMIS TME: five key zones of risk from the surgeons’ view. Int J Colorectal Dis. 2015;30:71–8.

    Article  PubMed  Google Scholar 

  10. Kneist W, Wolloscheck T, Konerding MA, Junginger T. Chirurgische Anatomie und neurophysiologische Parameter zur intraoperativen Identifikation und Funktionsprüfung autonomer Beckennerven bei TME wegen Rektumkarzinom. In: Haas NP, Neugebauer E, Bauer H (Pub.) Chirurgisches Forum 2003 für experimentelle und klinische Forschung. Forumband, 32. Heidelberg: Springer; 2003, p. 203–5.

    Google Scholar 

  11. Stelzner F. Der vergessene Sphincter ani internus im Mittelpunkt des anorektalen Kontinenzorgans. In: Stelzner F (Pub.) Chirurgie an viszeralen Abschlußsystemen. Stuttgart: Thieme; 1998, p. 188–96.

    Google Scholar 

  12. Stelzner F, Fleischhauer K, Holstein AF. Die Bedeutung des Sphincter internus für die Analkontinenz. Langenbecks Arch Chir. 1966;314:132–6.

    Article  CAS  PubMed  Google Scholar 

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Kneist, W. (2017). Pelvic Autonomic Nerve Preservation during Total Mesorectal Excision (TME) from Werner Kneist. In: Korenkov, M., Germer, CT., Lang, H. (eds) Gastrointestinal Operations and Technical Variations. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49878-1_50

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  • DOI: https://doi.org/10.1007/978-3-662-49878-1_50

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