Jonas F Schiemer1, Lennart Zimniak1, Edin Hadzijusufovic1, Hauke Lang1, Werner Kneist2. 1. Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. 2. Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. werner.kneist@unimedizin-mainz.de.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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Authors: S Stelzner; M Böttner; J Kupsch; W Kneist; P Quirke; N P West; H Witzigmann; T Wedel Journal: Colorectal Dis Date: 2018-01 Impact factor: 3.788
Authors: David Jayne; Alessio Pigazzi; Helen Marshall; Julie Croft; Neil Corrigan; Joanne Copeland; Phil Quirke; Nick West; Tero Rautio; Niels Thomassen; Henry Tilney; Mark Gudgeon; Paolo Pietro Bianchi; Richard Edlin; Claire Hulme; Julia Brown Journal: JAMA Date: 2017-10-24 Impact factor: 56.272
Authors: Jonas F Schiemer; Yen-Yi Y Juo; Yas Sanaiha; Anne Y Lin; Kevork Kazanjian; Hauke Lang; Werner Kneist Journal: J Minim Access Surg Date: 2018-03-23 Impact factor: 1.407