Along the Pelvic Side Walls

In the upper part with the hypogastric nerves in view, the presacral (retrorectal) space is entered. Then the dissection is carried out further laterally and downwards. It should be mentioned that more distally the pelvic splanchnic nerves (N. erigentes) join the hypogastric nerve and form the inferior hypogastric plexus. The lateral ligaments (stalks) which contain also the accessory middle rectal vessels seem to be adhered between the mesorectum and the nerve plexus. The vessels are often very small and can be divided easily with electrocautery. Alternatively, the ligaments are clamped, divided and ligated. Good ten-sion/countertension of the specimen and a good light source to visualise the border of the mesorectum are always important to avoid inadvertent bleeding.

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