European Surgical Research
Original Paper
Surface Electromyography Reliably Records Electrophysiologically Evoked Internal Anal Sphincter Activity: A More Minimally Invasive Approach for Monitoring Extrinsic InnervationKauff D.W.a · Wachter N.a · Heimann A.b · Krüger T.B.c · Hoffmann K.-P.d · Lang H.a · Kneist W.aaDepartment of General, Visceral and Transplant Surgery, and bInstitute for Neurosurgical Pathophysiology, University Medicine of the Johannes Gutenberg University, Mainz, cInomed Medizintechnik GmbH, Emmendingen, and dFraunhofer Institute for Biomedical Engineering, St. Ingbert, Germany
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Article / Publication Details
Received: January 19, 2016
Accepted: March 21, 2016
Published online: April 27, 2016
Issue release date: July 2016
Number of Print Pages: 8
Number of Figures: 7
Number of Tables: 0
ISSN: 0014-312X (Print)
eISSN: 1421-9921 (Online)
For additional information: https://www.karger.com/ESR
Abstract
Background: Even in the case of minimally invasive pelvic surgery, sparing of the autonomic nerve supply is a prerequisite for maintaining anal sphincter function. Internal anal sphincter (IAS) innervation could be electrophysiologically identified based on processed electromyographic (EMG) recordings with conventional bipolar needle electrodes (NE). This experimental study aimed for the development of a minimally invasive approach via intra-anal surface EMG for recordings of evoked IAS activity. Methods: Six male pigs underwent nerve-sparing low anterior rectal resection. Electric autonomic nerve stimulations were performed under online-processed EMG of the IAS. EMG recordings were simultaneously carried out with conventional bipolar NE as the reference method and newly developed intra-anal surface electrodes (SE) in different designs. Results: In all experiments, the IAS activity could be continuously visualized via EMG recordings based on NE and SE. The median number of bipolar electric stimulations per animal was 27 (range 5-52). The neurostimulations resulted in significant EMG amplitude increases for both recording types [NE: median 3.0 µV (interquartile range, IQR 2.8-3.5) before stimulation vs. 7.1 µV (IQR 3.9-13.8) during stimulation, p < 0.001; SE: median 3.6 µV (IQR 3.1-4.3) before stimulation vs. 6.8 µV (IQR 4.8-10.3) during stimulation, p < 0.001]. Conclusions: Intra-anal SE enabled reliable EMG of electrophysiologically evoked IAS activity similar to the conventional recording via NE. The transfer of the method to access platforms for transanal total mesorectal excision or robotics may offer a practical more minimally invasive approach for monitoring extrinsic innervation.
© 2016 S. Karger AG, Basel
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Article / Publication Details
Received: January 19, 2016
Accepted: March 21, 2016
Published online: April 27, 2016
Issue release date: July 2016
Number of Print Pages: 8
Number of Figures: 7
Number of Tables: 0
ISSN: 0014-312X (Print)
eISSN: 1421-9921 (Online)
For additional information: https://www.karger.com/ESR
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