Unit:
Κατεύθυνση Χειρουργική ΑνατομίαLibrary of the School of Health Sciences
Author:
Oikonomou Christiana
Supervisors info:
Παναγιώτης Σκανδαλάκης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Αντώνιος Μαζαράκης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Θεόδωρος Τρουπής, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Περινεϊκή Προσέγγιση της Χειρουργικής Ανατομίας του Περινέου και του Πυελικού Εδάφους
Translated title:
Bottom-up Approach of the Perineal Surgical Anatomy
Summary:
Neuroanatomy of the perineum remains a complex anatomical region for colorectal surgeons, especially when embarking on transanal and perineal procedures in the rectum, facing a reversed ‘bottom-up’ approach. The transanal approach for total mesorectal excision provides direct access under direct vision to the distal rectum and a more precise dissection of the distal portion of the mesorectal envelope. By this new technique, the surgeon overcomes the shortcomings of the standard procedure performed from above including poor visualization of the nerve plexuses and neurovascular bundles due to anatomical constraints imposed by obesity and a narrow pelvis. For nerve sparing surgery, sophisticated knowledge and a precise anatomical understanding of the perineum are important prerequisites for this reversed rectal approach.
Detailed knowledge regarding the neurogenic pathways in the perineum is also a mandatory condition when performing the extralevator abdominoperineal excision. This procedure results in superior oncologic outcome in the name of local recurrence for advanced low rectal cancer. The conventional abdominoperineal excision results in high rates of involved circumferential resection margins and of bowel perforation. The surgical specimen of the standard approach almost inevitably results in a “waist” at the level of puborectalis muscle in comparison to the extralevator approach that has been developed to avoid the “coning down” or “surgical waisting. The exact definition of the surgical resection planes is pivotal to achieve negative circumferential resection margins as well as to avoid neurological lesions postoperatively.
The aim of this thesis is to describe the crucial neurologic structures encountered during the described above procedures and define a roadmap of anatomical landmarks, for the caudal to cephalic approach, so as to ensure nerve sparing transanal and perineal rectal mobilization procedures.
Main subject category:
Health Sciences
Keywords:
Neuroanatomy, Perineum, Transanal, Extralevator approach
