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Wilhelm von Waldeyer-Hartz—A Great Forefather: His Contributions to Anatomy with Particular Attention to “His” Fascia

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      Abstract

      Wilhelm Waldeyer was, at his time, one of the most well-known authors in the field of Anatomy, Pathology, and Embryology. He held various distinguished academic positions. He was Professor of (Pathological) Anatomy in Breslau, Strasbourg, and Berlin. He remained in Berlin for the unusually long period of 33.5 years, as Full Professor for Anatomy and Director of the Anatomical Institute. His great talent as a teacher ensured that his lectures were always filled to the brim. Between 1862 and 1920, he published 270 works, including classics such as “Das Becken” (The Pelvis). The portrayal of this most important area is counted as one of the most complete which has ever been accomplished in the field of topographic anatomy, it includes the description of the fascia of Waldeyer. He also coined the phrases “chromosome” and “neuron” with their anatomical–morphological concepts. Already during his lifetime, his teaching ability significantly preceded the research capacity. It would, however, be false to overshadow Waldeyer’s merits as a researcher. His main scientific merit is in his excellent summarizing interpretations of current questions of anatomy and evolution, which particularly shows his simultaneous gift as a researcher and a teacher.

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      Most cited references 38

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      Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer.

      Total mesorectal excision with autonomic nerve preservation for rectal cancer is based on the anatomy of the mesorectum and of the pelvic autonomic nerves. Cadaver dissections were performed to describe the relationship between these structures. Between the rectum and the sacrum a retrorectal space can be developed, lined anteriorly by the visceral leaf and posteriorly by the parietal leaf of the pelvic fascia. The hypogastric nerve runs anterior to the visceral fascia, from the sacral promontory in a laterocaudad direction. The splanchnic sacral nerves originate from the sacral foramina, posterior to the parietal fascia, and run caudad, laterally and anteriorly. After piercing the parietal layer of the pelvic fascia, approximately 4 cm from the midline, the sacral nerves run between a double layer of the visceral part of the pelvic fascia. The relationship between the hypogastric nerves, the splanchnic nerves and the pelvic fascia was comparable in all six specimens examined.
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        Ueber Karyokinese und ihre Beziehungen zu den Befruchtungsvorgängen

         W. Waldeyer (1888)
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          Extrafascial excision of the rectum: surgical anatomy of the fascia propria.

          It is now agreed that it is of vital importance to maintain the fascia propria as an intact envelope around the mesorectum to prevent tumor spillage while performing rectal excision for cancer. There are several surgical techniques described to achieve an intact fascial envelope, each arising from differing descriptions of the fascia propria of the rectum. The aim of this study was to describe the detailed surgical anatomy of the fascia propria. Thirteen rectal specimens surgically removed by the technique of extrafascial excision were subjected to gross inspection, dissection, and histologic and electron microscopic examination. The attachments, thickness, and composition of the fascia propria were determined. The fascia propria is a continuous fascial sleeve surrounding the rectum and mesorectum that can be dissected as a complete "sock" off a fresh extrafascial specimen. It is 154 (+/- 1 standard deviation = 61-391) microm thick, is thinner anteriorly than posteriorly (P < 0.05), and is composed predominantly of collagen. It can be identified surgically at the pelvic brim as a shiny membrane and lies inside the hypogastric nerves and the pelvic plexuses. The fascia propria forms a sleeve around the mesorectum, offering a surface against which to dissect, enabling safe removal of the rectum with its intact mesorectum while preserving the autonomic nerves of the pelvis. The term "extrafascial excision" highlights the importance of the fascia propria in this operation.
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            Author and article information

            Affiliations
            1Department for General and Visceral Surgery, St. Vincenz Hospital , Paderborn, Germany
            2Pathology Paderborn , Paderborn, Germany
            3Department of Surgery and Center for Minimally Invasive Surgery, Vivantes Hospital , Berlin, Germany
            Author notes

            Edited by: Hesham Abdeldayem, National Liver Institute, Egypt

            Reviewed by: Premkumar Balachandran, Apollo Hospitals, India; Clive J. Kelty, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom

            *Correspondence: Ferdinand Köckerling, ferdinand.koeckerling@ 123456vivantes.de

            Specialty section: This article was submitted to Visceral Surgery, a section of the journal Frontiers in Surgery

            Contributors
            URI : http://frontiersin.org/people/u/130095
            URI : http://frontiersin.org/people/u/124616
            Journal
            Front Surg
            Front Surg
            Front. Surg.
            Frontiers in Surgery
            Frontiers Media S.A.
            2296-875X
            04 December 2017
            2017
            : 4
            5723023
            10.3389/fsurg.2017.00074
            Copyright © 2017 Scheuerlein, Henschke and Köckerling.

            This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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            Figures: 3, Tables: 0, Equations: 0, References: 39, Pages: 7, Words: 4616
            Categories
            Surgery
            Review

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