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International Journal of Colorectal Disease

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01-11-2010 | Original Article

Intraoperative pelvic nerve stimulation performed under continuous electromyography of the internal anal sphincter

Authors: Werner Kneist, Daniel W. Kauff, Roman K. Rahimi Nedjat, Andreas D. Rink, Axel Heimann, Karin Somerlik, Klaus P. Koch, Thomas Doerge, Hauke Lang

Published in: International Journal of Colorectal Disease | Issue 11/2010

Abstract

Purpose

The aim of this animal study was to investigate the effect of intraoperative pelvic nerve stimulation on internal anal sphincter electromyographic signals in order to evaluate its possible use for neuromonitoring during nerve-sparing pelvic surgery.

Methods

Eight pigs underwent low anterior rectal resection. The intersphincteric space was exposed, and the internal (IAS) and external anal sphincter (EAS) were identified. Electromyography of both sphincters was performed with bipolar needle electrodes. Intermittent bipolar electric stimulation of the inferior hypogastric plexus and the pelvic splanchnic nerves was carried out bilaterally. The recorded signals were analyzed in its frequency spectrum.

Results

In all animals, electromyographic recordings of IAS and EAS were successful. Intraoperative nerve stimulation resulted in a sudden amplitude increase in the time-based electromyographic signals of IAS (1.0 (0.5–9.0) μV vs. 4.0 (1.0–113.0) μV) and EAS (p < 0.001). The frequency spectrum of IAS in the resting state ranged from 0.15 to 5 Hz with highest activity in median at 0.77 Hz (46 cycles/min). Pelvic nerve stimulation resulted in an extended spectrum ranging from 0.15 to 20 Hz. EAS signals showed higher frequencies mainly in a range of 50 to 350 Hz. However, after muscle relaxation with pancuronium bromide, only the low frequency spectrum of the IAS signals was still present.

Conclusions

Intraoperative verification of IAS function by stimulation of pelvic autonomic nerves is possible. The IAS electromyographic response could be used to monitor pelvic autonomic nerve preservation.

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Title: Intraoperative pelvic nerve stimulation performed under continuous electromyography of the internal anal sphincter
Authors: Werner Kneist
Daniel W. Kauff
Roman K. Rahimi Nedjat
Andreas D. Rink
Axel Heimann
Karin Somerlik
Klaus P. Koch
Thomas Doerge
Hauke Lang
Publication date: 01-11-2010
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 11/2010
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-010-1015-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intraoperative pelvic nerve stimulation performed under continuous electromyography of the internal anal sphincter

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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