Anatomy of the lateral ligaments of the rectum: A controversial point of view

Figure 1 Illustration of the anatomy of the lateral ligament of the rectum. 1: Internal iliac artery; 2: Lateral ligament of the rectum; 3: Denonvilliers’ fascia; 4: Distal part of the rectum; 5: Inter-fascial space around the distal rectum; 6: Waldeyer fascia; 7: Mesorectum; 8: Presacral fascia.

Figure 2 Operative photographs of open total mesorectal excision of rectal cancer. A: Under open surgery view, no ligament structures can be revealed in a correct surgical plane. Arrow indicates parietal pelvic fascia; B: Rectum has been removed completely. Arrow indicates rectum visceral fascia, and the rectum visceral fascia extends around the rectum, forming a continuous “hammock-like’’ sheath.

Figure 3 Operative photograph of laparoscopic total mesorectal excision of rectal cancer. 1: Left lateral ligament of the rectum; 2: Superior fascia of pelvic diaphragm; 3: Rectum visceral fascia; 4: Levator ani.