Transcutaneous sacral nerve stimulation for intraoperative verification of internal anal sphincter innervation

Background The current standard for pelvic intraoperative neuromonitoring (pIONM) is based on intermittent direct nerve stimulation. This study investigated the potential use of transcutaneous sacral nerve stimulation for non‐invasive verification of pelvic autonomic nerves. Methods A consecutive se...

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Bibliographic Details
Published in:Neurogastroenterology and motility 2017-12, Vol.29 (12), p.n/a
Main Authors: Kauff, D. W., Moszkowski, T., Wegner, C., Heimann, A., Hoffmann, K.‐P., Krüger, T. B., Lang, H., Kneist, W.
Format: Article
Language:English
Subjects:
Anal Canal - innervation
Anal Canal - surgery
Animals
autonomic nerves
Autonomic nervous system
Cathodes
Digestive System Surgical Procedures - methods
Electromyography
Gynecologic Surgical Procedures - methods
Innervation
internal anal sphincter
intraoperative monitoring
Intraoperative Neurophysiological Monitoring - methods
Male
Nerves
Pelvis
Rectum
sacral nerve stimulation
Sacrum
Sphincter
Swine
transcutaneous
Transcutaneous Electric Nerve Stimulation - methods
Urologic Surgical Procedures - methods
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Summary:Background The current standard for pelvic intraoperative neuromonitoring (pIONM) is based on intermittent direct nerve stimulation. This study investigated the potential use of transcutaneous sacral nerve stimulation for non‐invasive verification of pelvic autonomic nerves. Methods A consecutive series of six pigs underwent low anterior rectal resection. For transcutaneous sacral nerve stimulation, an array of ten electrodes (cathodes) was placed over the sacral foramina (S2 to S4). Anodes were applied on the back, right and left thigh, lower abdomen, and intra‐anally. Stimulation using the novel method and current standard were performed at different phases of the experiments under electromyography of the autonomic innervated internal anal sphincter (IAS). Key Results Transcutaneous stimulation induced increase of IAS activity could be observed in each animal under specific cathode‐anode configurations. Out of 300 tested configurations, 18 exhibited a change in the IAS activity correlated with intentional autonomic nerve damage. The damage resulted in a significant decrease of the relative area under the curve of the IAS frequency spectrum (P
ISSN:1350-1925
1365-2982
DOI:10.1111/nmo.13140