Electrophysiology-based quality assurance of nerve-sparing in laparoscopic rectal cancer surgery: Is it worth the effort?

Surgical Endoscopy
D W KauffW Kneist

Abstract

After low anterior resection for rectal cancer, visual assessment of pelvic autonomic nerve preservation can be difficult due to the complexity of neuroanatomy, as well as surgery- and patient-related factors. The present study aimed to evaluate nerve-sparing quality assurance using the laparoscopic neuromapping (LNM) technique. We prospectively investigated a series of 30 patients undergoing laparoscopic low anterior resection. Nerve-sparing was evaluated both visually and electrophysiologically. LNM was performed using stimulation of pelvic autonomic nerves under simultaneous cystomanometry and processed electromyography of the internal anal sphincter. Urogenital and anorectal functions were evaluated using validated and standardized questionnaires preoperatively, at short-term follow-up, and at mid-term follow-up at a median of 9 months (range 6-12 months) after surgery. One patient reported new onset of urinary dysfunction, and another patient reported new onset of anorectal dysfunction. Of the 20 sexually active patients, five reported sexual dysfunction. Visual assessment by laparoscopy confirmed complete nerve preservation in 28 of 30 cases. For prediction of urinary and anorectal function, LNM sensitivity, specificity, ...Continue Reading

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Citations

Jun 23, 2016·Minimally Invasive Therapy & Allied Technologies : MITAT : Official Journal of the Society for Minimally Invasive Therapy·Werner KneistHauke Lang
Jul 7, 2017·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·D W KauffW Kneist
Apr 6, 2017·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Daniel W KauffWerner Kneist
Jun 6, 2018·Techniques in Coloproctology·Jonas F SchiemerWerner Kneist
Jul 28, 2020·Langenbeck's Archives of Surgery·Fabio NoceraDaniel C Steinemann
May 13, 2017·International Journal of Colorectal Disease·V CelentanoM Chand
Oct 31, 2020·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·Takuya ShiraishiKoji Ikeda
Mar 10, 2021·International Journal of Colorectal Disease·Athina A SamaraKonstantinos Tepetes
Aug 20, 2021·International Journal of Colorectal Disease·Alfredo AnnicchiaricoPaolo Prosperi

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