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

Schuler, Ramona; Marquardt, Christoph; Kalev, Georgi; Langer, Andreas; Konschake, Marko; Schiedeck, Thomas; Bandura, Julia; Goos, Matthias

doi:10.1038/s41598-023-41859-y

Cited by 3 publications

(1 citation statement)

References 32 publications

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“…This underscores the significance of considering the entire surgical procedure in assessing the risk and occurrence of pelvic nerve injuries. While the dissection of pelvic nerves presents technical challenges, the synergistic application of minimally invasive techniques, fluorescence-guided surgery utilizing dedicated immunostaining, and computerized imaging collectively enhances the delineation of pelvic organs and clarifies their innervation [ 69 ]. The incorporation of three-dimensional (3D) models facilitates a more comprehensive understanding of complex anatomic structures [ 70 , 71 ].…”

Section: The Surgeon- and Patient-centric Approach: The Different Lev...mentioning

confidence: 99%

Inferior Mesenteric Artery Ligation Level in Rectal Cancer Surgery beyond Conventions: A Review

Brillantino,

Skokowski,

Ciarleglio

et al. 2023

Cancers

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Within the intricate field of rectal cancer surgery, the contentious debate over the optimal level of ligation of the inferior mesenteric artery (IMA) persists as an ongoing discussion, influencing surgical approaches and patient outcomes. This narrative review incorporates historical perspectives, technical considerations, and functional as well as oncological outcomes, addressing key questions related to anastomotic leakage risks, genitourinary function, and oncological concerns, providing a more critical understanding of the well-known inconclusive evidence. Beyond the dichotomy of high versus low tie, it navigates the complexities of colorectal cancer surgery with a fresh perspective, posing a transformative question: “Is low tie ligation truly reproducible?” Considering a multidimensional approach that enhances patient outcomes by integrating the surgeon, patient, technique, and technology, instead of a rigid and categorical statement, we argued that a balanced response to this challenging question may require compromise.

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Section: The Surgeon- and Patient-centric Approach: The Different Lev...mentioning

confidence: 99%

Inferior Mesenteric Artery Ligation Level in Rectal Cancer Surgery beyond Conventions: A Review

Brillantino,

Skokowski,

Ciarleglio

et al. 2023

Cancers

View full text Add to dashboard Cite

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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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Urinary and sexual dysfunction after rectal cancer surgery: A surgical challenge

Kolokotronis,

Pantelis

2024

World J Gastroenterol

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This manuscript focused on the surgical challenge of urinary and sexual dysfunction after rectal cancer surgery based on the interesting results demonstrated by the observational study of Chen et al , which was published in the World Journal of Gastrointestinal Surgery . Urinary dysfunction occurs in one-third of patients treated for rectal cancer. Surgical nerve damage is the main cause of urinary dysfunction. Radiotherapy seems to exacerbate sexual dysfunction. The role of Denonvilliers' fascia preservation vs resection when performing total mesorectal excision (TME), the impact of robotic and transanal TME, alternatives to open and laparoscopic TME, as well as intraoperative pelvic neuromonitoring are discussed in this report. In conclusion, exact knowledge of the highly complex pelvic neuroanatomy and the use of novel surgical techniques can lead to a reduction in urinary and sexual dysfunction after rectal cancer surgery.

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

Cited by 3 publications

References 32 publications

Inferior Mesenteric Artery Ligation Level in Rectal Cancer Surgery beyond Conventions: A Review

Inferior Mesenteric Artery Ligation Level in Rectal Cancer Surgery beyond Conventions: A Review

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

Urinary and sexual dysfunction after rectal cancer surgery: A surgical challenge

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