Postprocessing algorithm for automated analysis of pelvic intraoperative neuromonitoring signals

Wegner, Celine; Krueger, Thilo B.; Hoffmann, Klaus‐Peter; Kauff, Daniel W.; Kneist, W.

doi:10.1515/cdbme-2016-0043

Cited by 4 publications

(1 citation statement)

References 6 publications

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“…An increased EMG activity on the IAS during direct stimulation of functional nerves is rated as a positive signal response. Bladder response is measured by increased intravesical pressure, which requires bladder filling with Ringer’s solution for each stimulation period 5 , 19 – 21 .…”

Section: Introductionmentioning

confidence: 99%

Technical aspects of a new approach to intraoperative pelvic neuromonitoring during robotic rectal surgery

Schuler,

Marquardt,

Kalev

et al. 2023

Sci Rep

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It has been found that rectal surgery still leads to high rates of postoperative urinary, fecal, or sexual dysfunction, which is why nerve-sparing surgery has gained increasing importance. To improve functional outcomes, techniques to preserve pelvic autonomic nerves by identifying anatomic landmarks and implementing intraoperative neuromonitoring methods have been investigated. The objective of this study was to transfer a new approach to intraoperative pelvic neuromonitoring based on bioimpedance measurement to a clinical setting. Thirty patients (16 male, 14 female) involved in a prospective clinical investigation (German Clinical Trials Register DRKS00017437, date of first registration 31/03/2020) underwent nerve-sparing rectal surgery using a new approach to intraoperative pelvic neuromonitoring based on direct nerve stimulation and impedance measurement on target organs. Clinical feasibility of the method was outlined in 93.3% of the cases. Smooth muscle contraction of the urinary bladder and/ or the rectum in response to direct stimulation of innervating functional nerves correlated with a change in tissue impedance compared with the pre-contraction state. The mean amplitude (Amax) of positive signal responses was Amax = 3.8%, negative signal responses from a control tissue portion with no stimulation-induced impedance change had an amplitude variation of 0.4% on average. The amplitudes of positive and negative signal responses differed significantly (statistical analysis using two-sided t-test), allowing the nerves to be identified and preserved. The results indicate a reliable identification of pelvic autonomic nerves during rectal surgery.

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Section: Introductionmentioning

confidence: 99%

Technical aspects of a new approach to intraoperative pelvic neuromonitoring during robotic rectal surgery

Schuler,

Marquardt,

Kalev

et al. 2023

Sci Rep

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show abstract

Intraoperative pelvic neuromonitoring based on bioimpedance signals: a new method analyzed on 30 patients

Kalev,

Schuler,

Langer

et al. 2024

Langenbecks Arch Surg

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Purpose Increasing importance has been attributed in recent years to the preservation of the pelvic autonomic nerves during rectal resection to achieve better functional results. In addition to improved surgical techniques, intraoperative neuromonitoring may be useful. Methods This single-arm prospective study included 30 patients who underwent rectal resection performed with intraoperative neuromonitoring by recording the change in the tissue impedance of the urinary bladder and rectum after stimulation of the pelvic autonomic nerves. The International Prostate Symptom Score, the post-void residual urine volume and the Low Anterior Resection Syndrome Score (LARS score) were assessed during the 12-month follow-up period. Results A stimulation-induced change in tissue impedance was observed in 28/30 patients (93.3%). In the presence of risk factors such as low anastomosis, neoadjuvant radiotherapy and a deviation stoma, an average increase of the LARS score by 9 points was observed 12 months after surgery (p = 0,04). The function of the urinary bladder remained unaffected in the first week (p = 0,7) as well as 12 months after the procedure (p = 0,93). Conclusion The clinical feasibility of the new method for pelvic intraoperative neuromonitoring could be verified. The benefits of intraoperative pelvic neuromonitoring were particularly evident in difficult intraoperative situations with challenging visualization of the pelvic nerves.

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Automatic muscle impedance and nerve analyzer (AMINA) as a novel approach for classifying bioimpedance signals in intraoperative pelvic neuromonitoring

Schuler,

Langer,

Marquardt

et al. 2024

Sci Rep

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Frequent complications arising from low anterior resections include urinary and fecal incontinence, as well as sexual disorders, which are commonly associated with damage to the pelvic autonomic nerves during surgery. To assist the surgeon in preserving pelvic autonomic nerves, a novel approach for intraoperative pelvic neuromonitoring was investigated that is based on impedance measurements of the innervated organs. The objective of this work was to develop an algorithm called AMINA to classify the bioimpedance signals, with the goal of facilitating signal interpretation for the surgeon. Thirty patients included in a clinical investigation underwent nerve-preserving robotic rectal surgery using intraoperative pelvic neuromonitoring. Contraction of the urinary bladder and/or rectum, triggered by direct stimulation of the innervating nerves, resulted in a change in tissue impedance signal, allowing the nerves to be identified and preserved. Impedance signal characteristics in the time domain and the time–frequency domain were calculated and classified to develop the AMINA. Stimulation-induced positive impedance changes were statistically significantly different from negative stimulation responses by the percent amplitude of impedance change Amax in the time domain. Positive impedance changes and artifacts were distinguished by classifying wavelet scales resulting from peak detection in the continuous wavelet transform scalogram, which allowed implementation of a decision tree underlying the AMINA. The sensitivity of the software-based signal evaluation by the AMINA was 96.3%, whereas its specificity was 91.2%. This approach streamlines and automates the interpretation of impedance signals during intraoperative pelvic neuromonitoring.

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Postprocessing algorithm for automated analysis of pelvic intraoperative neuromonitoring signals

Cited by 4 publications

References 6 publications

Technical aspects of a new approach to intraoperative pelvic neuromonitoring during robotic rectal surgery

Technical aspects of a new approach to intraoperative pelvic neuromonitoring during robotic rectal surgery

Intraoperative pelvic neuromonitoring based on bioimpedance signals: a new method analyzed on 30 patients

Automatic muscle impedance and nerve analyzer (AMINA) as a novel approach for classifying bioimpedance signals in intraoperative pelvic neuromonitoring

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