In transanal total mesorectal excision (TaTME), compared to laparoscopic TME, which specific anatomical plane is approached from the perineal route to avoid the most critical complication of urethral injury?

• A Waldeyer's fascia posteriorly to identify the presacral plane
• B Toldt's fascia laterally for mesorectal mobilization
• C Rectosacral ligament at the level of S4
• D Denonvilliers' fascia anteriorly between rectum and seminal vesicles ✓

Explanation

In TaTME, the most hazardous step in male patients is anterior dissection where Denonvilliers' fascia separates the rectum from the seminal vesicles and prostate. Going anterior to this fascia risks entering the prostatic plane and injuring the urethra or neurovascular bundles. The correct plane is posterior to Denonvilliers' fascia. Waldeyer's fascia posteriorly is a landmark for the posterior presacral plane. Toldt's fascia is a retroperitoneal plane unrelated to the pelvic dissection. The rectosacral ligament at S4 is a posterior landmark for rectal mobilization, not the anterior danger zone.

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

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Written and medically reviewed by the StethoPrep medical team.