Search results for "Autonomic nerve"
showing 10 items of 20 documents
Intraoperative identification and neurophysiologic parameters to verify pelvic autonomic nerve function during total mesorectal excision for rectal c…
2003
Abstract Background Preservation of parasympathetic and sympathetic nerves is required to avoid urogenital function disturbances after total mesorectal excision (TME) for rectal carcinoma. This study sought to determine whether intraoperative stimulation of parasympathetic nerves with monitoring of bladder contraction is useful in meeting this demand. Study design In a prospective pilot study, 17 patients, 11 men and 6 women, underwent TME with pelvic autonomic nerve preservation performed by an experienced surgeon. The parasympathetic nerves were stimulated by an electrostimulation device (Screener 3625, Medronic), and the resulting bladder contraction was measured manometrically in all pa…
Extracorporeal Stimulation of Sacral Nerve Roots for Observation of Pelvic Autonomic Nerve Integrity: Description of a Novel Methodological Setup.
2017
Introduction: Neurophysiologic monitoring can improve autonomic nerve sparing during critical phases of rectal cancer surgery. Objectives: To develop a system for extracorporeal stimulation of sacral nerve roots. Methods: Dedicated software controlled a ten-electrode stimulation array by switching between different electrode configurations and current levels. A built-in impedance and current level measurement assessed the effectiveness of current injection. Intra-anal surface electromyography (sEMG) informed on targeting the sacral nerve roots. All tests were performed on five pig specimens. Results: During switching between electrode configurations, the system delivered 100% of the set cur…
Pelvic Autonomic Nerve Preservation during Total Mesorectal Excision (TME) from Werner Kneist
2017
According to the German guideline for “Colorectal Cancer,” total mesorectal excision (TME) removes the cancer located at the central and lower thirds of the rectum and the pelvic floor while preserving the superior hypogastric plexus (SHP), the hypogastric nerves, and the inferior hypogastric plexus (IHP) (recommendation level A, level of evidence 1b, strong consensus). Intraoperative nerve damage is to be avoided to preserve postoperative quality of life with the premise of radical surgery. It is particularly necessary to preserve autonomously controlled urogenital and anorectal functions. Among other things, this presumes a fundamental understanding of current events on surgical topograph…
Surgeons’ assessment of internal anal sphincter nerve supply during TaTME - inbetween expectations and reality
2016
Abstract Background: Intraoperative identification of nerve fibers heading from the inferior rectal plexus (IRP) to the internal anal sphincter (IAS) is challenging. The transanal total mesorectal excision (TaTME) is said to better preserve pelvic autonomic nerves. The aim of this study was to investigate the nerve identification rates during TaTME by transanal visual and electrophysiological assessment. Material and methods: A total of 52 patients underwent TaTME for malignant conditions. The IRP with its posterior branches to the IAS and the pelvic splanchnic nerves (PSN) were visually assessed in 20 patients (v-TaTME). Electrophysiological nerve identification was performed in 32 patient…
Online signal processing of internal anal sphincter activity during pelvic autonomic nerve stimulation: a new method to improve the reliability of in…
2011
Aim Intra-operative neuromonitoring is increasingly applied in several surgical disciplines and has been introduced to facilitate pelvic autonomic nerve preservation. Nevertheless, it has been considered a questionable tool for the minimization of risk, as the results are variable and might be misleading. The aim of the present experimental study was to develop an intra-operative neuromonitoring system with improved reliability for monitoring pelvic autonomic nerve function. Method Fifteen pigs underwent low anterior rectal resection with pelvic autonomic nerve preservation. Intra-operative neuromonitoring was performed under autonomic nerve stimulation with observation of electromyograph…
Total mesorectal excision - does the choice of dissection technique have an impact on pelvic autonomic nerve preservation?
2011
Background The aim of this experimental study was to assess the quality of pelvic autonomic nerve preservation of different dissection techniques.
Surgical and anatomical basis of autonomic nerve-preserving mesorectal excision for rectal cancer
2003
Adequate knowledge of the anatomy of the pelvis is a prerequisite to carry out a correct surgical technique in resection of rectal cancer. In this way, we can perform radical surgery, preserve the autonomic nerves and decrease local recurrence and urinary and sexual morbidity. The key to all this and the difference in results depends on a meticulous and detailed surgical technique.
Autonomic Nerve Blocks
1988
Selective block of the sympathetic trunk was first reported by Sellheim and, shortly thereafter, by Lawen, Kappis, and Finsterer (1905–1910). In 1924, reports were published by Brumm and Mandl and by Swertlow. After 1930, the technique and the indications were established by White in the United States and Leriche and Fontaine in Europe.
Surface Electromyography Reliably Records Electrophysiologically Evoked Internal Anal Sphincter Activity: A More Minimally Invasive Approach for Moni…
2016
<b><i>Background:</i></b> Even in the case of minimally invasive pelvic surgery, sparing of the autonomic nerve supply is a prerequisite for maintaining anal sphincter function. Internal anal sphincter (IAS) innervation could be electrophysiologically identified based on processed electromyographic (EMG) recordings with conventional bipolar needle electrodes (NE). This experimental study aimed for the development of a minimally invasive approach via intra-anal surface EMG for recordings of evoked IAS activity. <b><i>Methods:</i></b> Six male pigs underwent nerve-sparing low anterior rectal resection. Electric autonomic nerve stimulations were …
Residual urine volume after total mesorectal excision: an indicator of pelvic autonomic nerve preservation? Results of a case-control study.
2004
Objective The rate of bladder dysfunctions after total mesorectal excision (TME) for rectal cancer can be decreased by bilateral pelvic autonomic nerve preservation (PANP). However, it is not clear yet, how often partial nerve impairment may lead to bladder dysfunction. It was the aim of a case-control study, to examine the residual urine volume in patients before and after TME with and without complete PANP, in order to clarify, whether this parameter allows conclusions on the quality of PANP. Patients and methods Regarding bladder function, a case group (n = 26) without complete PANP was compared with a control group (n = 26) with complete identification and nerve preservation according…