In transanal total mesorectal excision (TaTME) for rectal cancer, the 'holy plane' of sharp dissection is between:

• A The visceral and parietal peritoneum
• B The muscularis propria and submucosa
• C Waldeyer's fascia and the levator ani muscle
• D The visceral (mesorectal) fascia and the parietal (presacral) fascia ✓

Explanation

Total mesorectal excision (TME) — whether transabdominal or transanal — is performed in the 'holy plane' described by Heald, which lies between the visceral (mesorectal) fascia investing the mesorectum and the parietal (presacral/endopelvic) fascia covering the sacral plexus and hypogastric nerves. Staying in this avascular areolar plane ensures an intact mesorectal envelope, minimizes blood loss, and preserves autonomic nerves. Waldeyer's fascia is a condensation of the parietal fascia at S4 and is incised during TME to access the distal rectum.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.