title: Pelvic intraoperative neuromonitoring during robotic-assisted low anterior resection for rectal cancer.
abstract: While the oncological outcome of patients with rectal cancer has been considerably improved within the last decades, anorectal, urinary and sexual functions remained impaired at high levels, regardless of whether radical surgery was performed open or laparoscopically. Consequently, intraoperative monitoring of the autonomic pelvic nerves with simultaneous electromyography of the internal anal sphincter and manometry of the urinary bladder has been introduced to advance nerve-sparing surgery and to improve functional outcome. Initial results suggested that pelvic neuromonitoring may result in better functional outcomes. Very recently, it has also been demonstrated that minimally invasive neuromonitoring is technically feasible. Because, to the best of our knowledge, pelvic neuromonitoring has not been performed during robotic surgery, we report the first case of robotic-assisted low anterior rectal resection combined with intraoperative monitoring of the autonomic pelvic nerves.
authors.affiliation: Department of General, Visceral and Pediatric Surgery, University Medical Center, Robert-Koch-Str. 40, 37075, Goettingen, Germany. marian.grade@med.uni-goettingen.de.
authors.forename: Marian
authors.initials: M
authors.lastname: Grade
authors.affiliation: Department of General, Visceral and Pediatric Surgery, University Medical Center, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Beham
authors.affiliation: Department of General, Visceral and Pediatric Surgery, University Medical Center, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Schüler
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Kneist
authors.affiliation: Department of General, Visceral and Pediatric Surgery, University Medical Center, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
authors.forename: B Michael
authors.initials: BM
authors.lastname: Ghadimi
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D001341:Autonomic Nervous System / Q000601:surgery; D004576:Electromyography; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008991:Monitoring, Physiologic; D059351:Organ Sparing Treatments; D010388:Pelvis / Q000294:innervation; D012004:Rectal Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods*; D020196:Trauma, Nervous System / Q000517:prevention & control
keywords: Autonomic pelvic nerves; Intraoperative neuromonitoring; Low anterior rectal resection; Nerve-sparing total mesorectal excision; Rectal cancer; Robotic surgery