title: Nerve-oriented mesorectal excision (NOME): autonomic nerves as landmarks for laparoscopic rectal resection.
abstract: OBJECTIVE
  We have developed nerve-oriented mesorectal excision (NOME) as a novel concept in rectal cancer surgery by which autonomic pelvic nerves serve as landmarks for a standardized navigation along fascial planes. This article describes the technique step by step and presents our results from 2008 to 2012.
  
  
  METHODS
  The key steps are: preparation of the splanchnic nerves at the mid-posterior sidewall, the hypogastric nerves at the upper sidewall, and the urogenital nerve branches (Walsh) at the caudal-anterior sidewall. The dissection of the lateral ligament is strictly performed as the last step. NOME was applied in 274 consecutive mesorectal excisions (partial 20.4%, total 79.6%); a subgroup of 42 male patients underwent a questionnaire-based interview on sexual activity.
  
  
  RESULTS
  The conversion rate was 0.7%. High (complete) specimen quality and circumferential margin negativity were achieved in 90.1% and 95.3%, respectively. Anastomotic leaks occurred in 13 (4.7%) patients. Mortality was 1.8%. The frequency of prolonged urinary catheter was 1.8%. Of 22 sexually active males interviewed, 18 (81.8%) maintained activity postoperatively.
  
  
  CONCLUSIONS
  NOME achieves high-quality mesorectal specimens and a high rate of preservation of autonomic nerve function. The concept of using nerves as laparoscopic landmarks may help to standardize and master laparoscopic rectal cancer surgery.
authors.affiliation: Department of General Surgery, Schwarzwald-Baar-Klinikum, Teaching Hospital of the University of Freiburg, Vöhrenbacher Str. 25, 78050, Villingen-Schwenningen, Germany, avc@sbk-vs.de.
authors.forename: Norbert
authors.initials: N
authors.lastname: Runkel
authors.forename: Harald
authors.initials: H
authors.lastname: Reiser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks; D017776:Autonomic Pathways / Q000601:surgery*; D004210:Dissection; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*