Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
Tech Coloproctol. 2018 Jun;22(6):445-448. doi: 10.1007/s10151-018-1804-3. Epub 2018 Jun 4.
Pelvic intraoperative neuromonitoring during nerve-sparing robot-assisted total mesorectal excision (RTME) is feasible. However, visual separation of the neuromonitoring process from the surgeon console interrupts the workflow and limits the usefulness of available information as the procedure progresses. Since the robotic surgical system provides multi-image views in the surgeon console, the aim of this study was to integrate cystomanometry and internal anal sphincter electromyography signals to aid the robotic surgeon in his/her nerve-sparing technique.
We prospectively investigated 5 consecutive patients (1 male, 4 females) who underwent RTME for rectal cancer at our institution in 2017. The robotic surgery was performed using the da Vinci Xi combined with pelvic intraoperative neuromapping with real-time electromyography and cystomanometry signal transmission by multi-image view during RTME.
The adapted two-dimensional pelvic intraoperative neuromonitoring imaging successfully simulcasted to the surgeon console view in all 5 cases. The technical note is complemented by an intraoperative video.
This report demonstrates the technical feasibility of an improved neuromonitoring process during nerve-sparing RTME. Robotic neuromapping can be fully visualized from the surgeon console.
在保留神经的机器人辅助全直肠系膜切除术（RTME）中进行骨盆术中神经监测是可行的。然而，将神经监测过程与外科控制台视觉分离会中断工作流程，并限制随着手术进程的进行可用信息的实用性。由于机器人手术系统在外科控制台中提供多图像视图，因此本研究的目的是将膀胱测压和内括约肌肌电图信号集成到机器人外科医生的神经保留技术中。
我们前瞻性研究了 2017 年在我们机构接受 RTME 治疗直肠肿瘤的 5 例连续患者（1 例男性，4 例女性）。使用 da Vinci Xi 进行机器人手术，并结合实时肌电图的骨盆术中神经映射以及在 RTME 期间通过多图像视图传输的膀胱测压和内括约肌肌电图信号。
在所有 5 例患者中，适应的二维骨盆术中神经监测成像均成功地实时传输到外科控制台视图。该技术说明附有术中视频。
本报告证明了在保留神经的 RTME 过程中改进神经监测过程的技术可行性。机器人神经映射可以从外科控制台完全可视化。
