Electrophysiology-based quality assurance of nerve-sparing in laparoscopic rectal cancer surgery: Is it worth the effort?

Kauff, Daniel W.; Wachter, Nicolas; Bettzieche, R.; Lang, Hauke; Kneist, W.

doi:10.1007/s00464-016-4787-z

Cited by 16 publications

(12 citation statements)

References 25 publications

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“…Preoperative assessment and treatment algorithm were based on a colorectal-specific multidisciplinary team discussion. Patients were preoperatively categorized with regard to the intraoperative difficulty level for pelvic autonomic nerve preservation based on surgery- and patient-related factors ( 12 ). Forty-four patients were preoperatively categorized as grade III (more problematic) and nine as grade IV (very problematic).…”

Section: Methodsmentioning

confidence: 99%

Surgeons’ assessment of internal anal sphincter nerve supply during TaTME - inbetween expectations and reality

Kneist

Hanke

Kauff

et al. 2016

Minimally Invasive Therapy & Allied Technologies

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Background: Intraoperative identification of nerve fibers heading from the inferior rectal plexus (IRP) to the internal anal sphincter (IAS) is challenging. The transanal total mesorectal excision (TaTME) is said to better preserve pelvic autonomic nerves. The aim of this study was to investigate the nerve identification rates during TaTME by transanal visual and electrophysiological assessment. Material and methods: A total of 52 patients underwent TaTME for malignant conditions. The IRP with its posterior branches to the IAS and the pelvic splanchnic nerves (PSN) were visually assessed in 20 patients (v-TaTME). Electrophysiological nerve identification was performed in 32 patients using electric stimulation under processed electromyography of IAS (e-TaTME). Results: The indication profile for TaTME was comparable between the v-TaTME and the e-TaTME group. The identification of IRP was more meaningful under electrophysiological assessment than under visual assessment for the left pelvic side (81% vs. 45%, p = 0.008) as well as the right pelvic side (78% vs. 45%, p = 0.016). The identification rates for PSN did not significantly differ between both groups, respectively (81% vs. 75%, p = 0.420 and 84% vs. 70%, p = 0.187). Conclusions: The transanal approach facilitated visual identification of IAS nerve supply. In combination with electrophysiological nerve assessment the identification rate almost doubled. For further insights functional data are needed.

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Section: Methodsmentioning

confidence: 99%

Surgeons’ assessment of internal anal sphincter nerve supply during TaTME - inbetween expectations and reality

Kneist

Hanke

Kauff

et al. 2016

Minimally Invasive Therapy & Allied Technologies

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“…Rektumresektion konnte in einer monozentrischen prospektiven Fallstudie mit 30 Patienten gezeigt werden, dass die laparoskopische Durchführung des pIONM die postoperative Blasenfunktion anhand der Zystomanometrie und die anale Funktion anhand des EMG vom IAS ebenso erfolgreich vorhersagen kann [17]. Allerdings scheint die Erfassung der postoperativen Sexualfunktion etwas ungenauer zu sein.…”

Section: Nach Positiver Evaluierung Bei Der Offenenunclassified

“…Allerdings scheint die Erfassung der postoperativen Sexualfunktion etwas ungenauer zu sein. Bei 20 sexuell aktiven Patienten wurde die postoperative Funktion durch Kombination von Zystomanometrie-und EMG-Ergebnissen dennoch mit einer Treffsicherheit von 90 % vorhergesagt (Sensitivität 80 %; Spezifität 93 %; positiver prädiktiver Wert 80 %; negativer prädiktiver Wert 93 %) [17]. Möglicherweise können so bereits frühzeitig diejenigen Patienten identifiziert werden, die eine sexuelle Funktionsstörung ausbilden, und bei denen somit eine rechtzeitige Anbindung an entsprechende Spezialisten sinnvoll ist.…”

Section: Nach Positiver Evaluierung Bei Der Offenenunclassified

Stellenwert des intraoperativen Neuromonitorings in der roboterassistierten Rektumchirurgie

Flebbe¹,

Beham²,

Schüler³

et al. 2018

Zentralbl Chir

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“…Ongoing technical and methodological developments enabled further application of pIONM ® during laparoscopic [2,3] and robotic-assisted low anterior resection [4]. The current pIONM ® method is based on intracorporeal electric neurostimulation under needle electromyography (EMG) of internal anal sphincter (IAS) and manometry of urinary bladder.…”

Section: Introductionmentioning

confidence: 99%

Postprocessing algorithm for automated analysis of pelvic intraoperative neuromonitoring signals

Wegner

Krueger

Hoffmann

et al. 2016

Current Directions in Biomedical Engineering

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Electrophysiology-based quality assurance of nerve-sparing in laparoscopic rectal cancer surgery: Is it worth the effort?

Abstract: LNM is an appropriate method for reliable quality assurance of laparoscopic nerve-sparing.

Cited by 16 publications

References 25 publications

Surgeons’ assessment of internal anal sphincter nerve supply during TaTME - inbetween expectations and reality

Surgeons’ assessment of internal anal sphincter nerve supply during TaTME - inbetween expectations and reality

Stellenwert des intraoperativen Neuromonitorings in der roboterassistierten Rektumchirurgie

Postprocessing algorithm for automated analysis of pelvic intraoperative neuromonitoring signals

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