Pelvic intraoperative neuromonitoring during robotic-assisted low anterior resection for rectal cancer

Marian Grade, Alexander W Beham, P Schüler, Werner Kneist, B Michael Ghadimi, Marian Grade, Alexander W Beham, P Schüler, Werner Kneist, B Michael Ghadimi

Abstract

While the oncological outcome of patients with rectal cancer has been considerably improved within the last decades, anorectal, urinary and sexual functions remained impaired at high levels, regardless of whether radical surgery was performed open or laparoscopically. Consequently, intraoperative monitoring of the autonomic pelvic nerves with simultaneous electromyography of the internal anal sphincter and manometry of the urinary bladder has been introduced to advance nerve-sparing surgery and to improve functional outcome. Initial results suggested that pelvic neuromonitoring may result in better functional outcomes. Very recently, it has also been demonstrated that minimally invasive neuromonitoring is technically feasible. Because, to the best of our knowledge, pelvic neuromonitoring has not been performed during robotic surgery, we report the first case of robotic-assisted low anterior rectal resection combined with intraoperative monitoring of the autonomic pelvic nerves.

Keywords: Autonomic pelvic nerves; Intraoperative neuromonitoring; Low anterior rectal resection; Nerve-sparing total mesorectal excision; Rectal cancer; Robotic surgery.

Figures

Fig. 1
Fig. 1
Simultaneous electromyography of the internal anal sphincter (upper panel) and manometry of the urinary bladder (lower panel)

References

    1. Cunningham D, Atkin W, Lenz HJ, Lynch HT, Minsky B, Nordlinger B, Starling N. Colorectal cancer. Lancet. 2010;375(9719):1030–1047. doi: 10.1016/S0140-6736(10)60353-4.
    1. Wallner C, Lange MM, Bonsing BA, Maas CP, Wallace CN, Dabhoiwala NF, Rutten HJ, Lamers WH, Deruiter MC, van de Velde CJ, Cooperative Clinical Investigators of the Dutch Total Mesorectal Excision Trial Causes of fecal and urinary incontinence after total mesorectal excision for rectal cancer based on cadaveric surgery: a study from the cooperative clinical investigators of the Dutch total mesorectal excision trial. J Clin Oncol. 2008;26(27):4466–4472. doi: 10.1200/JCO.2008.17.3062.
    1. Lange MM, van de Velde CJ. Urinary and sexual dysfunction after rectal cancer treatment. Nat Rev Urol. 2011;8(1):51–57. doi: 10.1038/nrurol.2010.206.
    1. Emmertsen KJ, Laurberg S, Rectal Cancer Function Study Group Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg. 2013;100(10):1377–1387. doi: 10.1002/bjs.9223.
    1. Andersson J, Abis G, Gellerstedt M, Angenete E, Angerås U, Cuesta MA, Jess P, Rosenberg J, Bonjer HJ, Haglind E. Patient-reported genitourinary dysfunction after laparoscopic and open rectal cancer surgery in a randomized trial (COLOR II) Br J Surg. 2014;101(10):1272–1279. doi: 10.1002/bjs.9550.
    1. Collinson FJ, Jayne DG, Pigazzi A, Tsang C, Barrie JM, Edlin R, Garbett C, Guillou P, Holloway I, Howard H, Marshall H, McCabe C, Pavitt S, Quirke P, Rivers CS, Brown JM. An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Colorectal Dis. 2012;27(2):233–241. doi: 10.1007/s00384-011-1313-6.
    1. Kauff DW, Koch KP, Somerlik KH, Hoffmann KP, Lang H, Kneist W. Evaluation of two-dimensional intraoperative neuromonitoring for predicting urinary and anorectal function after rectal cancer surgery. Int J Colorectal Dis. 2013;28(5):659–664. doi: 10.1007/s00384-013-1662-4.
    1. Kneist W, Kauff DW, Juhre V, Hoffmann KP, Lang H. Is intraoperative neuromonitoring associated with better functional outcome in patients undergoing open TME? Results of a case-control study. Eur J Surg Oncol. 2013;39(9):994–999. doi: 10.1016/j.ejso.2013.06.004.
    1. Kneist W, Kauff DW, Rubenwolf P, Thomas C, Hampel C, Lang H. Intraoperative monitoring of bladder and internal anal sphincter innervation: a predictor of erectile function following low anterior rectal resection for rectal cancer? Results of a prospective clinical study. Dig Surg. 2013;30(4–6):459–465. doi: 10.1159/000357349.
    1. Kneist W, Kauff DW, Lang H. Laparoscopic neuromapping in pelvic surgery: scopes of application. Surg Innov. 2014;21(2):213–220. doi: 10.1177/1553350613496907.
    1. Lee JF, Maurer VM, Block GE. Anatomic relations of pelvic autonomic nerves to pelvic operations. Arch Surg. 1973;107(2):324–328. doi: 10.1001/archsurg.1973.01350200184038.
    1. Havenga K, DeRuiter MC, Enker WE, Welvaart K. Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer. Br J Surg. 1996;83(3):384–388. doi: 10.1002/bjs.1800830329.
    1. Lindsey I, Guy RJ, Warren BF, Mortensen NJ. Anatomy of Denonvilliers’ fascia and pelvic nerves, impotence, and implications for the colorectal surgeon. Br J Surg. 2000;87(10):1288–1299. doi: 10.1046/j.1365-2168.2000.01542.x.
    1. Clausen N, Wolloscheck T, Konerding MA. How to optimize autonomic nerve preservation in total mesorectal excision: clinical topography and morphology of pelvic nerves and fasciae. World J Surg. 2008;32(8):1768–1775. doi: 10.1007/s00268-008-9625-6.
    1. Moszkowicz D, Alsaid B, Bessede T, Penna C, Nordlinger B, Benoît G, Peschaud F. Where does pelvic nerve injury occur during rectal surgery for cancer? Colorectal Dis. 2011;13(12):1326–1334. doi: 10.1111/j.1463-1318.2010.02384.x.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться