📙📜Holy plane of Heald📜📙
🔴Dissection is along the avascular alveolar plane between the presacral and mesorectal fascia, described as holy plane (Heald’s “holy plane”).
🔴The mesorectum refers to a fatty connective tissue layer, measuring 2–3 cm in thickness, with associated vessels, lymphatics and lymph nodes, which surrounds the rectum and is enveloped by fascia.
🔴mesorectal dissection occurs in a total avascular plane that, once identified, can be easily dissected, exposing ‘the white side of the yellow’ as Heald first described in 1979. As the posterior dissection continues downward, the mesorectum looks more and more bilobate (indicating a good quality of the dissection) until it thins out and disappears.
Once again traction and counter traction are essential in lateral and anterior resection to identify the dissection plane.
🔴The relationship of the rectum and pelvic autonomic nerves during open surgery when standing on the patient’s left. The ligation of the inferior mesenteric artery should be performed 1.5–2 cm from its origin from the aorta to avoid damaging the superior hypogastric plexus. At the pelvis, for posterior and lateral tumours, dissection should be directed below the Denonvillliers fascia to avoid damaging the neurovascular bundles that run along the tip of the seminal vesicle (2 and 10 o’clock directions).
#Arrangoiz #Surgeon #Teacher #CancerSurgeon #CASO #Miami #CenterforAdvancedSurgicalOncology