Technique of neuromonitoring during pelvic peritonectomy

Abstract

ObjectivesPelvic peritonectomy can induce anorectal and urogenital dysfunctions. To reduce this type of complications during the procedure, we propose to use intraoperative neuromonitoring (IONM).ContentStimulation with a bipolar probe allows the identification of the obturator and ilioinguinal and pudendal nerves. At the end of the cytoreductive surgery, the motor and somatosensory evoked potentials must be evaluated to confirm the preservation of pelvic innervation.SummaryThe use of IONM during pelvic peritonectomy is technically feasible, and it can help to preserve pelvic nerves.OutlookObviously, its definitive value remains to be elucidated.

A new method of intraoperative pelvic neuromonitoring: a preclinical feasibility study in a porcine model

“…Other methods for pelvic floor neuromonitoring are bulbocavernosus reflex (BCR) measurements, recording of transcranial motor evoked potentials (tcMEPs) and somatosensory evoked potential recordings (SSEPs) from the pudendal nerve 30 . The bulbocavernosus reflex (BCR) is a method for functional control of the reflex arc at the sacral spinal level S2-S4 via afferent and efferent fibers of the pudendal nerve from the clitoris/glans penis to the motor pelvic floor muscles.…”

“…The bulbocavernosus reflex (BCR) is a method for functional control of the reflex arc at the sacral spinal level S2-S4 via afferent and efferent fibers of the pudendal nerve from the clitoris/glans penis to the motor pelvic floor muscles. This method is typically used for spinal procedures at the sacral level and for procedures in the lesser pelvis 16 , 30 . BCR is not used to monitor pelvic autonomic nerves such as the superior or inferior hypogastric plexus, which is the most important difference from the impedance measurement method presented.…”

“…TcMEPs used for pelvic neuromonitoring include transcranial stimulation of the motor cortex and MEP measurement at the external urethral sphincter (EUS) and external anal sphincter (EAS), both of which are motor muscles innervated by the pudendal nerve. This method is useful for sacral spine procedures as well as pelvic procedures where the pudendal nerve is at risk 16 , 30 . Direct identification of the pelvic autonomic nerves in the surgical area is not possible with the MEP method.…”

Giant sacral schwannoma excised under intraoperative neuromonitoring in an elderly patient: case report

“…In case of recurrence, postoperative morbidity is much greater due to secondary adhesions to the first surgery; in addition, in case of relapse, the risk of malignant transformation increases [ 14 ]. The recent implementation of intraoperative neuromonitoring seems to be associated with a complications rate reduction [ 4 , 8 , 9 , 11–13 , 15 ]. In our experience, this has allowed an easier discernment of functional nervous tissue, allowing an en-block removal without long-term complications, but only a transient deficit with a rapid functional recovery, even in an elderly patient.…”

“…The patient underwent a surgical resection through a single stage procedure in combination with neuromonitoring. The neuromonitoring paradigm consisted of transcranial motor evoked potential (TCeMEPs), as well as spontaneous EMG (free-run EMG) recorded from the external anal sphincter (EAS), bulbocavernosus (BULB) and lower extremity muscles bilaterally [ 11 ]. Moreover, the lumbosacral plexus and the pudendal nerve were monitored by direct current stimulation of the nerves.…”