During total mesorectal excision for mid-rectal cancer, the surgeon must dissect in the avascular plane between the mesorectal fascia and the pelvic sidewall fascia. What is this plane called?

• A Denonvilliers' fascia
• B Waldeyer's fascia
• C Presacral space
• D Holy plane (Heald's plane) ✓

Explanation

The 'holy plane' described by Heald is the avascular areolar tissue plane between the visceral mesorectal fascia and the parietal pelvic sidewall fascia. Dissection in this plane ensures complete mesorectal excision with preservation of autonomic nerves. Denonvilliers' fascia separates rectum from prostate/vagina. Waldeyer's fascia attaches rectum to sacrum.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.