The lateral connective tissue envelope of the mesorectum, forming the "holy plane" of TME dissection between the mesorectal fascia and the parietal endopelvic fascia.
Defines the surgical plane of total mesorectal excision, separating the oncological specimen from the pelvic sidewall autonomic nerves.
The pararectal fascia plane is the critical anatomy of TME surgery. Sharp dissection in this embryological fusion plane between visceral (mesorectal) and parietal (endopelvic) fascia achieves an intact mesorectal specimen with negative circumferential margins and preserves the hypogastric and splanchnic nerves.
Entering the wrong plane outside the pararectal fascia during TME breaches the mesorectal envelope, risks a positive circumferential margin, and may injure the ureters or pelvic autonomic nerves.
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