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

International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

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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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Authors and Affiliations

  1. Department of General Surgery, Schwarzwald-Baar-Klinikum, Teaching Hospital of the University of Freiburg, Vöhrenbacher Str. 25, 78050, Villingen-Schwenningen, Germany

    Norbert Runkel & Harald Reiser

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  1. Norbert Runkel
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  2. Harald Reiser
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Correspondence to Norbert Runkel.

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Runkel, N., Reiser, H. Nerve-oriented mesorectal excision (NOME): autonomic nerves as landmarks for laparoscopic rectal resection. Int J Colorectal Dis 28, 1367–1375 (2013). https://doi.org/10.1007/s00384-013-1705-x

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