Cargando…

Surgeons’ assessment of internal anal sphincter nerve supply during TaTME - inbetween expectations and reality

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 th...

Descripción completa

Detalles Bibliográficos
Autores principales: Kneist, Werner, Hanke, Laura, Kauff, Daniel W., Lang, Hauke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044775/
https://www.ncbi.nlm.nih.gov/pubmed/27333465
http://dx.doi.org/10.1080/13645706.2016.1197269
_version_ 1782457003753340928
author Kneist, Werner
Hanke, Laura
Kauff, Daniel W.
Lang, Hauke
author_facet Kneist, Werner
Hanke, Laura
Kauff, Daniel W.
Lang, Hauke
author_sort Kneist, Werner
collection PubMed
description 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 patients using electric stimulation under processed electromyography of IAS (e-TaTME). Results: The indication profile for TaTME was comparable between the v-TaTME and the e-TaTME group. The identification of IRP was more meaningful under electrophysiological assessment than under visual assessment for the left pelvic side (81% vs. 45%, p = 0.008) as well as the right pelvic side (78% vs. 45%, p = 0.016). The identification rates for PSN did not significantly differ between both groups, respectively (81% vs. 75%, p = 0.420 and 84% vs. 70%, p = 0.187). Conclusions: The transanal approach facilitated visual identification of IAS nerve supply. In combination with electrophysiological nerve assessment the identification rate almost doubled. For further insights functional data are needed.
format Online
Article
Text
id pubmed-5044775
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Taylor & Francis
record_format MEDLINE/PubMed
spelling pubmed-50447752016-10-12 Surgeons’ assessment of internal anal sphincter nerve supply during TaTME - inbetween expectations and reality Kneist, Werner Hanke, Laura Kauff, Daniel W. Lang, Hauke Minim Invasive Ther Allied Technol Original Article 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 patients using electric stimulation under processed electromyography of IAS (e-TaTME). Results: The indication profile for TaTME was comparable between the v-TaTME and the e-TaTME group. The identification of IRP was more meaningful under electrophysiological assessment than under visual assessment for the left pelvic side (81% vs. 45%, p = 0.008) as well as the right pelvic side (78% vs. 45%, p = 0.016). The identification rates for PSN did not significantly differ between both groups, respectively (81% vs. 75%, p = 0.420 and 84% vs. 70%, p = 0.187). Conclusions: The transanal approach facilitated visual identification of IAS nerve supply. In combination with electrophysiological nerve assessment the identification rate almost doubled. For further insights functional data are needed. Taylor & Francis 2016-09-02 2016-06-22 /pmc/articles/PMC5044775/ /pubmed/27333465 http://dx.doi.org/10.1080/13645706.2016.1197269 Text en © 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
spellingShingle Original Article
Kneist, Werner
Hanke, Laura
Kauff, Daniel W.
Lang, Hauke
Surgeons’ assessment of internal anal sphincter nerve supply during TaTME - inbetween expectations and reality
title Surgeons’ assessment of internal anal sphincter nerve supply during TaTME - inbetween expectations and reality
title_full Surgeons’ assessment of internal anal sphincter nerve supply during TaTME - inbetween expectations and reality
title_fullStr Surgeons’ assessment of internal anal sphincter nerve supply during TaTME - inbetween expectations and reality
title_full_unstemmed Surgeons’ assessment of internal anal sphincter nerve supply during TaTME - inbetween expectations and reality
title_short Surgeons’ assessment of internal anal sphincter nerve supply during TaTME - inbetween expectations and reality
title_sort surgeons’ assessment of internal anal sphincter nerve supply during tatme - inbetween expectations and reality
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044775/
https://www.ncbi.nlm.nih.gov/pubmed/27333465
http://dx.doi.org/10.1080/13645706.2016.1197269
work_keys_str_mv AT kneistwerner surgeonsassessmentofinternalanalsphincternervesupplyduringtatmeinbetweenexpectationsandreality
AT hankelaura surgeonsassessmentofinternalanalsphincternervesupplyduringtatmeinbetweenexpectationsandreality
AT kauffdanielw surgeonsassessmentofinternalanalsphincternervesupplyduringtatmeinbetweenexpectationsandreality
AT langhauke surgeonsassessmentofinternalanalsphincternervesupplyduringtatmeinbetweenexpectationsandreality