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Re-exploring the pelvic neuroanatomy from a new perspective and a potential guidance for TaTME: a “bottom-up” approach

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Abstract

Neuro-anatomy of the perineum has gained renewed attention due to its significance in the transanal procedures for rectal cancer (eg TaTME). Surgeons embarking on this technique must have sophisticated knowledge and a precise anatomical understanding of the perineum before proceeding with this reversed rectal approach. We report anatomical observations deriving from a relevant experience in the colorectal surgery field. The collective multicenter experience of the present study is clinically relevant and based on the rectal and transanal resections performed in colorectal centers of excellence from Greece, UK, and Italy over the last 10 years (2011–2020). From the original anatomical and intraoperative observations derived from collective cases operated by this multicenter group of colorectal surgical centers in three European countries, data were retrieved and analyzed in collaboration with specialist researchers of human anatomy and interpreted for their clinical significance and potential use for preoperative planning and intraoperative guidance during TaTME. This descriptive article demonstrates in detail the neurogenic pathways encountered in the perineum and pelvic cavity during transanal procedures. Specific anatomical and topographic implications are also included serving as a guide for colorectal surgeons to perform a nerve-sparing procedure. transanal approach for rectal excision offers new insights into the complex pelvic and perineal neuroanatomy while the procedure itself remains a challenge for surgeons. Preoperative anatomical planning and 3D reconstruction may help in anticipating technical difficulties, resulting in more precise surgical dissections and decreased postoperative complications.

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Acknowledgements

The members of the Pelvic-Neuroanatomy Collaborating Group are: Dr. Andrea Vigezzi, Dr. Gaetano Gallo, Dr. Francesco Pata, Dr. Francesco Di Marzo, Prof. Nicola De’ Angelis, Dr. Antonio Giuliani, Prof Giovanni Lezoche, Prof. Mario Guerrieri

Author information

Authors and Affiliations

  1. Fifth Colorectal Surgical Department, Metropolitan General Hospital, Athens, Greece

    Christiana Oikonomou

  2. Department of Surgery, Addenbrooke’s Cambridge University Hospitals, Cambridge, UK

    Stavros Gourgiotis & Salomone Di Saverio

  3. Department of General Surgery and Medical - Surgical Specialties, University of Perugia, Perugia, Italy

    Roberto Cirocchi

  4. Department of Anatomy, Medical School, National and Kapodestrian University of Athens, Athens, Greece

    Maria Piagkou, Vasilios Protogerou, Theodoros Troupis & Antonio Biondi

  5. Department of General Surgery and Medical - Surgical Specialties, University of Catania, Catania, Italy

    Dimitrios Filippou

  6. Department of Surgery, University VitaSalute, San Raffaele Hospital, Milano, Italy

    Pierpaolo Sileri

  7. Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge Biomedical CampusHills Road, Box 201, Cambridge, CB2 0QQ, UK

    Salomone Di Saverio

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  1. Christiana Oikonomou
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Consortia

Pelvic-Neuroanatomy Collaborating Group

  • Andrea Vigezzi
  • , Gaetano Gallo
  • , Francesco Pata
  • , Francesco Di Marzo
  • , Nicola De’ Angelis
  • , Antonio Giuliani
  • , Giovanni Lezoche
  •  & Mario Guerrieri

Corresponding author

Correspondence to Salomone Di Saverio.

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Research involving human participants and/or animals

The ethics committee and review board in our institute approved the study and treatment protocol.

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The members of the Pelvic-Neuroanatomy Collaborating Group are listed in acknowledgements.

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Supplementary Video: 3D and Visual Video reconstruction of the pelvic anatomy with annotated landamrks (avi 227,437 KB)

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Oikonomou, C., Gourgiotis, S., Cirocchi, R. et al. Re-exploring the pelvic neuroanatomy from a new perspective and a potential guidance for TaTME: a “bottom-up” approach. Updates Surg 73, 503–512 (2021). https://doi.org/10.1007/s13304-020-00968-3

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  • DOI: https://doi.org/10.1007/s13304-020-00968-3

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