Research and Development, Dr. Langer Medical GmbH, Waldkirch, Germany.
Institute of Biomedical Engineering and Informatics, TU Ilmenau, Ilmenau, Germany.
Sci Rep. 2022 Mar 7;12(1):3696. doi: 10.1038/s41598-022-07576-8.
Low anterior resections (LAR) are frequently associated with complications such as urinary and fecal incontinence as well as sexual disorders. Typical risk factors are rectal cancer with low tumor location, preoperative radiotherapy, and surgery-related damage of pelvic autonomic nerves. As preserving the pelvic autonomic nerves without any technical assistance is challenging, the objective of this preclinical study was to investigate the technical feasibility of a new method for intraoperative pelvic neuromonitoring. Twelve female pigs undergoing low anterior resections were involved in a prospective preclinical study. Intraoperative pelvic neuromonitoring included direct pelvic nerve stimulation and tissue impedance measurement on the urinary bladder and the rectum for the identification of efferent pelvic nerves in the surgical area. Immunohistochemistry was used to verify the results. Smooth muscle contraction of the urinary bladder and/or the rectum in response to direct stimulation of the innervating nerves was detectable with impedance measurement. The macroscopic contraction of both the urinary bladder and the rectum correlated with a change in tissue impedance compared to the status before contraction. Thus, it was possible to identify pelvic nerves in the surgical area, which allows the nerves to be preserved. The results indicate a reliable identification of pelvic autonomic nerves, which allows nerve damage to be prevented in the future.
低位前切除术（LAR）常伴有尿失禁、粪失禁和性功能障碍等并发症。典型的危险因素是直肠肿瘤位置低、术前放疗以及与手术相关的骨盆自主神经损伤。由于在没有任何技术辅助的情况下保留骨盆自主神经具有挑战性，因此本临床前研究的目的是探讨一种新的术中骨盆神经监测方法的技术可行性。12 头接受低位前切除术的雌性猪参与了前瞻性临床前研究。术中骨盆神经监测包括直接对膀胱和直肠的盆腔神经进行刺激和组织阻抗测量，以识别手术区域的传出盆腔神经。免疫组织化学用于验证结果。通过阻抗测量可以检测到受支配神经直接刺激时膀胱和/或直肠的平滑肌收缩。与收缩前的状态相比，膀胱和直肠的宏观收缩与组织阻抗的变化相关。因此，可以识别手术区域中的骨盆神经，从而可以保留这些神经。结果表明可以可靠地识别骨盆自主神经，从而可以防止未来的神经损伤。
