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Clinical Trial
. 2016 Oct;25(5):241-6.
doi: 10.1080/13645706.2016.1197269. Epub 2016 Jun 22.

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

Werner Kneist  1 , Laura Hanke  1 , Daniel W Kauff  1 , Hauke Lang  1
Affiliations
Clinical Trial

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

Werner Kneist et al. Minim Invasive Ther Allied Technol. 2016 Oct.

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 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.

Keywords: Rectal cancer; TaTME; autonomic nerves; total mesorectal excision; transanal surgery.

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Figures

Figure 1.
Figure 1.
Vertical organized inferior hypogastric plexus (star) with superior, central and inferior branches and its sympathetic/parasympathetic sources. Hypogastric nerve marked with arrow. Cadaver dissection via abdominal surgical approach with Prof. Dr. med. M. Herrmann (Institute of Anatomy, University of Ulm)
Figure 2.
Figure 2.
Visually assessed tiny nerve fibers heading to the internal anal sphincter (arrows)
Figure 3.
Figure 3.
Pelvic splanchnic nerves located posterolaterally running along the right pelvic side wall to intermingle with the inferior hypogastric plexus.
Figure 4.
Figure 4.
Electrophysiologically assessed posterior branches of the inferior rectal plexus (arrows). Former exidental opening of levators fascia (star)
See this image and copyright information in PMC

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