title: Laparoscopic neuromapping in pelvic surgery: scopes of application.
abstract: BACKGROUND
  New developments in intraoperative electrophysiological neuromonitoring for conventional surgery are providing further insights into functional neuroanatomy and nerve-sparing in the minor pelvis. The aim of this study was to open up potential scopes of application in laparoscopy.
  
  
  METHODS
  Ten patients with different indications for surgery (presacral tumor excision, n = 2; resection rectopexy. n = 2; low anterior rectal resection, n = 2; proctocolectomy. n = 2; abdomino-perineal excision of the rectum, n = 2) were investigated prospectively. The pelvic autonomic nerves were bilaterally mapped by laparoscopic electric stimulation under simultaneous electromyography of the internal anal sphincter and manometry of the bladder. Stimulation results were compared to patients' anorectal and urogenital functional outcome.
  
  
  RESULTS
  In all the operations laparoscopic neuromapping (LNM) was technically feasible. Laparoscopy enabled excellent visibility of pelvic neural structures for simple and differentiated electric stimulation. In all cases LNM resulted in significantly evoked electromyographic potentials and intravesical pressure rises. The technique facilitated electrophysiological determination of functional neuroanatomical topography in the minor pelvis. The stimulation results were suitable to confirm laparoscopic nerve-sparing and compatible with patients' anorectal and urogenital functional outcome.
  
  
  CONCLUSIONS
  LNM is technically feasible and opens up a new dimension for verification of functional nerve integrity. Further developments and investigations are mandatory to evaluate its role for laparoscopic nerve-sparing procedures.
authors.affiliation: 1University Medicine of the Johannes Gutenberg-University Mainz, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Kneist
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Kauff
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000294:innervation / Q000601:surgery; D017776:Autonomic Pathways / Q000033:anatomy & histology* / Q000502:physiology; D004558:Electric Stimulation / Q000379:methods*; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010388:Pelvis / Q000294:innervation* / Q000601:surgery*; D055815:Young Adult
keywords: anal sphincter; autonomic nerves; electric stimulation; electromyography; intraoperative monitoring; laparoscopy