Intraoperative monitoring of pelvic autonomic nerves during laparoscopic low anterior resection of rectal cancer

Min-Wei Zhou, Xiao-Yun Huang, Zong-You Chen, Zhen-Yang Li, Yi-Ming Zhou, Yi Yang, Zi-Hao Wang, Jian-Bin Xiang, Xiao-Dong Gu, Min-Wei Zhou, Xiao-Yun Huang, Zong-You Chen, Zhen-Yang Li, Yi-Ming Zhou, Yi Yang, Zi-Hao Wang, Jian-Bin Xiang, Xiao-Dong Gu

Abstract

Background: Some patients with low rectal cancer experience anorectal and urogenital dysfunctions after surgery, which can influence the long-term quality of life. In this study, we aimed to protect nerve function in such scenarios by performing intraoperative monitoring of pelvic autonomic nerves (IMPAN).

Patients and methods: We retrospectively investigated a series of 87 patients undergoing laparoscopic low anterior resection of rectal cancer. Nerve-sparing was evaluated both visually and electrophysiologically. IMPAN was performed by stimulating the pelvic autonomic nerves under processed electromyography of the internal anal sphincter. Urination, defecation, sexual function, and the quality of life were evaluated using validated and standardized questionnaires preoperatively and at follow-up, 12 months after surgery.

Results: Among a total of 87 patients (53 male and 34 female patients), IMPAN with simultaneous electromyography of the internal anal sphincter was performed in 58 (66.7%) patients. Bilateral positive IMPAN results for both measurements, indicating successfully confirmed pelvic autonomic nerve preservation, were obtained in 45 (51.7%) patients. No significant difference was found in terms of urogenital and anorectal functions between preoperative and postoperative patients with bilateral positive IMPAN (P>0.05). Compared to preoperative patients with IMPAN (unilateral) or without IMPAN, these patients exhibited higher International Prostate Symptom Score, a lower International Index of Erectile Function-5, and a lower Female Sexual Function Index score at 12 months postoperatively (P<0.05).

Conclusion: IMPAN is an appropriate method with which to laparoscopically protect nerve function.

Keywords: intraoperative neuromonitoring; low anterior rectal resection; pelvic autonomic nerves; rectal cancer.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Bipolar probe for laparoscopic neuromonitoring in the pelvis.
Figure 2
Figure 2
Pelvic autonomic nerves stimulated by a bipolar probe during surgery. Note: (A) Intraoperative monitoring of SHP; (B) intraoperative monitoring of left hypogastric nerve; (C) intraoperative monitoring of right hypogastric nerve; and (D) intraoperative monitoring of right IHP. Abbreviations: IHP, inferior hypogastric plexus; IMA, inferior mesenteric artery; SHP, superior hypogastric plexus.

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