da Vinci robotic-assisted micro-space dissection and autonomic nerve network preservation technique in the total mesorectal excision procedure for rectal cancer: a single-center, retrospective, observational, real-world study

Abstract

Completely preserving the abdominopelvic autonomic nervous system technique during da Vinci robot-assisted rectal cancer surgery remains a challenge for surgeons. Anatomical studies reveal that the abdominopelvic autonomic nervous system resides within the prehypogastric nerve fascia sheath, exhibiting a reticular distribution with accompanying blood vessels surrounding neural fibers. This study proposes a novel autonomic nerve network preservation technique and delineates its technical nuances in robot-assisted total mesorectal excision (TME) for rectal cancer. The enhanced magnification capability of the da Vinci robotic surgical system enables precise dissection along the microanatomical plane between the fascia propria of rectum (FPR) and the prehepogastric nerve fascia sheath. By performing intermembrane micro-space dissection between the FPR and the prehypogastric nerve fascia sheath, the technology can preserve the autonomic nerve main trunks, branches, and vascular supply of autonomic nerves while minimizing bleeding and surgical trauma. This research summarizes our experience with 141 cases of middle and low rectal cancer undergoing da Vinci robotic-assisted autonomic nerve network preservation in the total mesorectal excision surgery from October 2020 to December 2024. There were no conversions to open or conventional laparoscopic techniques. Our preliminary data demonstrate preserved oncological efficacy while significantly reducing postoperative urinary and sexual dysfunction with concomitant improvement in recovery milestones.

Keywords: Autonomic nerve network preservation technique; Rectal cancer; Total mesorectal excision; da Vinci robot-assisted surgery.