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International Journal of Colorectal Disease

, Volume 28, Issue 10, pp 1367–1375 | Cite as

Nerve-oriented mesorectal excision (NOME): autonomic nerves as landmarks for laparoscopic rectal resection

  • Norbert Runkel
  • Harald Reiser
Original Article

Abstract

Purpose

We have developed nerve-oriented mesorectal excision (NOME) as a novel concept in rectal cancer surgery by which autonomic pelvic nerves serve as landmarks for a standardized navigation along fascial planes. This article describes the technique step by step and presents our results from 2008 to 2012.

Material and methods

The key steps are: preparation of the splanchnic nerves at the mid-posterior sidewall, the hypogastric nerves at the upper sidewall, and the urogenital nerve branches (Walsh) at the caudal-anterior sidewall. The dissection of the lateral ligament is strictly performed as the last step. NOME was applied in 274 consecutive mesorectal excisions (partial 20.4 %, total 79.6 %); a subgroup of 42 male patients underwent a questionnaire-based interview on sexual activity.

Results

The conversion rate was 0.7 %. High (complete) specimen quality and circumferential margin negativity were achieved in 90.1 % and 95.3 %, respectively. Anastomotic leaks occurred in 13 (4.7 %) patients. Mortality was 1.8 %. The frequency of prolonged urinary catheter was 1.8 %. Of 22 sexually active males interviewed, 18 (81.8 %) maintained activity postoperatively.

Conclusions

NOME achieves high-quality mesorectal specimens and a high rate of preservation of autonomic nerve function. The concept of using nerves as laparoscopic landmarks may help to standardize and master laparoscopic rectal cancer surgery.

Keywords

Laparoscopy Rectal cancer Total mesorectal excision Nerve preservation Autonomic pelvic nerves 

Notes

Acknowledgments

We are indebted to Tilo Wedel (Institute of Anatomy, University Hospital Schleswig-Holstein, Campus Kiel, Germany) for his advice and support for the paper.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of General Surgery, Schwarzwald-Baar-KlinikumTeaching Hospital of the University of FreiburgVillingen-SchwenningenGermany

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