Biomechanical origin of the Denonvilliers’ fascia
- 506 Downloads
Since 1836 and the first description of the recto-genital fascia by Charles Denonvilliers, many anatomists have shown interest in this subject. Recently, pelvic surgeons have in turn shown similar interest, for they consider that perfect knowledge of this anatomical domain is crucial for optimal nerve conservation during surgery. Thanks to new anatomical description techniques, fascia location and relationships with pelvic nerves now appear clearer.
To describe and represent Denonvilliers’ fascia and its relationships in the female foetus at different stages of gestation and in three-dimensional space (3D).
Materiel/patients and methods
Computer-assisted anatomical dissection technique was used. Serial histological sections were made from four human female foetuses. Sections were treated with conventional staining, as well as with nerve and smooth muscle immunostaining. Finally, the sections were digitalized and reconstructed in 3D.
Denonvilliers’ fascia was clearly located and visualized in three dimensions. It was present in the female foetus, being distinct from the fascia propria of the rectum. It appeared to be composed of multiple parallel layers situated between the vagina and the rectum. From a lateral view, it had an asymmetrical “Y-shaped” aspect that seemed to play the role of a protective sheet for the neurovascular bundles.
This study betters our comprehension of the Denonvilliers’ fascia in the female foetus and of its connections with pelvic nerves. It also provides a better understanding of safe planes during pelvic dissection. These findings also suggest a biomechanical theory for embryological origin of the Denonvilliers’ fascia.
KeywordsDenonvilliers’ fascia Embryology Neurovascular bundles Anatomy 3D reconstruction
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Alsaid B, Bessede T, Diallo D, Moszkowicz D, Karam I, Benoit G, Droupy S (2011) Division of autonomic nerves within the neurovascular bundles distally into corpora cavernosa and corpus spongiosum components: immunohistochemical confirmation with three-dimensional reconstruction. Eur Urol 59(6):902–909PubMedCrossRefGoogle Scholar
- 4.Alsaid B, Bessede T, Karam I, Abd-Alsamad I, Uhl JF, Benoit G, Droupy S, Delmas V (2009) Coexistence of adrenergic and cholinergic nerves in the inferior hypogastric plexus: anatomical and immunohistochemical study with 3D reconstruction in human male fetus. J Anat 214(5):645–654PubMedCrossRefGoogle Scholar
- 8.Cuneo B, Veau V (1899) De la signification morphologique des aponevroses périvésicales. J Anat Paris 35:235–245Google Scholar
- 9.Elliot Smith G (1908) Studies in the anatomy of the pelvis, with special reference to the fasciae and visceral supports. Part I. J Anat Physiol 42:198–218Google Scholar
- 16.Kinugasa Y, Murakami G, Uchimoto K, Takenaka A, Yajima T, Sugihara K (2006) Operating behind Denonvilliers’ fascia for reliable preservation of urogenital autonomic nerves in total mesorectal excision: a histologic study using cadaveric specimens, including a surgical experiment using fresh cadaveric models. Dis Colon Rectum 49(7):1024–1032PubMedCrossRefGoogle Scholar
- 17.Kiyoshima K, Yokomizo A, Yoshida T, Tomita K, Yonemasu H, Nakamura M, Oda Y, Naito S, Hasegawa Y (2004) Anatomical features of periprostatic tissue and its surroundings: a histological analysis of 79 radical retropubic prostatectomy specimens. Jpn J Clin Oncol 34(8):463–468PubMedCrossRefGoogle Scholar
- 26.Tobin C, Benjamin A (1945) Anatomical and surgical restudy of Denonvilliers’ fascia. Surg Gynecol Obstet 80:373–388Google Scholar
- 29.Wesson M (1922) The development and surgical importance of the recto-urethralis muscle and Denonvilliers’ fascia. J Urol 8:339–359Google Scholar