title: Continuous intraoperative monitoring of autonomic nerves during low anterior rectal resection: an innovative approach for observation of functional nerve integrity in pelvic surgery.
abstract: OBJECTIVE
  The aim of this study was to develop a methodological setup for continuous intraoperative neuromonitoring with intent to improve nerve-sparing pelvic surgery.
  
  
  METHODS
  Fourteen pigs underwent low anterior rectal resection. Continuous stimulation of pelvic autonomic nerves was carried out with a newly developed tripolar surface electrode during lateral, anterolateral, and anterior mesorectal dissection. Neuromonitoring was performed under electromyography of the autonomic innervated internal anal sphincter.
  
  
  RESULTS
  Continuous neuromonitoring resulted in significantly increased electromyographic amplitudes of the internal anal sphincter, confirming intact innervation throughout the whole dissection in each animal (median 0.9 μV, interquartile range 0.5; 1.5 vs. median 3.4 μV, interquartile range 2.1; 4.7) (p < 0.001). The median dissection time in each animal was 10 min within a median number of ten (range 8-13) tripolar electric stimulations.
  
  
  CONCLUSIONS
  The present study is the first to demonstrate that continuous intraoperative monitoring of pelvic autonomic nerves during low anterior rectal resection is feasible.
authors.affiliation: Department of General and Abdominal Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
authors.forename: D W
authors.initials: DW
authors.lastname: Kauff
authors.forename: O
authors.initials: O
authors.lastname: Kempski
authors.forename: K P
authors.initials: KP
authors.lastname: Koch
authors.forename: S
authors.initials: S
authors.lastname: Huppert
authors.forename: K P
authors.initials: KP
authors.lastname: Hoffmann
authors.forename: H
authors.initials: H
authors.lastname: Lang
authors.forename: W
authors.initials: W
authors.lastname: Kneist
mesh_terms: D001003:Anal Canal / Q000294:innervation* / Q000601:surgery*; D000818:Animals; D017776:Autonomic Pathways / Q000502:physiology* / Q000601:surgery; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D004558:Electric Stimulation / Q000379:methods; D004576:Electromyography / Q000379:methods; D005240:Feasibility Studies; D005242:Fecal Incontinence / Q000517:prevention & control; D008297:Male; D023421:Models, Animal; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D012007:Rectum / Q000294:innervation* / Q000601:surgery; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013552:Swine