The plane of surgical dissection in total mesorectal excision (TME) for rectal cancer is the:
- A Areolar plane between the visceral and parietal pelvic fascia (the 'holy plane') ✓
- B Plane between the mesorectal fascia and the presacral venous plexus
- C Plane immediately outside the muscularis propria of the rectum
- D Plane between the sigmoid mesocolon and the retroperitoneum
Correct answer: A. Areolar plane between the visceral and parietal pelvic fascia (the 'holy plane')
Explanation
TME as described by Heald involves sharp dissection in the avascular areolar plane between the visceral fascia (mesorectal fascia enveloping the mesorectum) and the parietal pelvic fascia (Waldeyer's fascia posteriorly, endopelvic fascia laterally). Heald termed this the 'holy plane'. This plane preserves the intact mesorectal envelope containing lymphatics and blood vessels while protecting the presacral nerves and presacral venous plexus. Dissection inside the mesorectal fascia risks leaving tumour deposits; dissection outside it risks nerve and vessel injury.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.