Intraoperative monitoring of pelvic autonomic nerves during laparoscopic low anterior resection of rectal cancer

Figures & data

Figure 1 Bipolar probe for laparoscopic neuromonitoring in the pelvis.

Figure 2 Pelvic autonomic nerves stimulated by a bipolar probe during surgery.

Note: (A) Intraoperative monitoring of SHP; (B) intraoperative monitoring of left hypogastric nerve; (C) intraoperative monitoring of right hypogastric nerve; and (D) intraoperative monitoring of right IHP.

Abbreviations: IHP, inferior hypogastric plexus; IMA, inferior mesenteric artery; SHP, superior hypogastric plexus.

Table 1 Characteristics of rectal cancer patients undergoing laparoscopic LAR with or without IMPAN

Patient characteristics		With IMPAN	Without IMPAN	P-value
Age (years)a		65 (45–80)	62 (55–78)	0.099
Gender	Male	36	17	0.565
	Female	22	12
ASA grade	I	32	15	0.074
	II	21	8
	III	5	6
Previous pelvic surgery	Yes	12	5	0.442
	No	46	24
Neoadjuvant chemoradiotherapy	Yes	19	7	0.083
	No	39	22
Tumor location (from anal verge)	>7 cm	24	14	0.378
	≤7 cm	34	15
Multi-visceral resection	Yes	14	9	0.198
	No	44	20
Tumor category	T1/T2	23	11	0.754
	T3/T4	35	18
Lymph node category	N negative	33	15	0.496
	N positive	25	14
Operation time (min)b		156.72±33.32	150.69±32.06	0.327
Blood loss (mL)b		102.16±65.10	113.45±78.25	0.237

Notes:

a Results are expressed as medians. Interquartile range is in parentheses.

b Results are expressed as mean ± SD.

Abbreviations: ASA, American Society of Anesthesiologists; IMPAN, intraoperative monitoring of pelvic autonomic nerves; LAR, low anterior resection.

Table 2 IPSS and quality of life due to urinary symptoms in patients with rectal cancer before surgery and at follow-up after LAR

Evaluation of urinary function	With IMPAN (unilateral) 13 patients			With IMPAN (bilateral) 45 patients			Without IMPAN 29 patients
	Before surgery	After surgery	P-value	Before surgery	After surgery	P-value	Before surgery	After surgery	P-value
IPSS	6.08±1.66	10.23±3.09	0.001	6.58±3.19	6.76±3.11	0.088	6.28±2.53	9.10±4.08	0.001
Quality of life	1.46±1.13	2.77±1.54	0.007	2.33±1.13	2.51±1.32	0.185	1.76±0.91	3.03±1.48	0.001

Notes: Results are expressed as mean ± SD at follow-up 6–9 months after stoma closure or 12 months after surgery in patients without a diverting stoma. P-values <0.05 are shown in bold.

Abbreviations: IMPAN, intraoperative monitoring of pelvic autonomic nerves; IPSS, International Prostate Symptom Score; LAR, low anterior resection.

Table 3 IIEF-5 scores in male patients before and at follow-up after LAR from rectal cancer

Evaluation of male sexual function	With IMPAN (unilateral) seven male patients			With IMPAN (bilateral) 28 male patients			Without IMPAN 18 male patients
	Before surgery	After surgery	P-value	Before surgery	After surgery	P-value	Before surgery	After surgery	P-value
IIEF -5	18.29±4.27	12.43±5.53	0.039	18.68±5.38	18.04±5.67	0.074	18.88±3.69	12.82±4.43	0.001

Notes: Results are expressed as mean ± SD at follow-up 6–9 months after stoma closure or 12 months after surgery in patients without a diverting stoma. P-values <0.05 are shown in bold.

Abbreviations: IIEF, International Index of Erectile Function; IMPAN, intraoperative monitoring of pelvic autonomic nerves; LAR, low anterior resection.

Table 4 FSFI scores in female patients with rectal cancer prior to surgery and at follow-up after LAR

Evaluation of female sexual function	With IMPAN (unilateral) six female patients			With IMPAN (bilateral) 17 female patients			Without IMPAN eleven female patients
	Before surgery	After surgery	P-value	Before surgery	After surgery	P-value	Before surgery	After surgery	P-value
FSFI	17.33±6.95	10.50±4.37	0.002	16.76±6.13	16.53±6.32	0.299	17.28±5.73	11.00±4.88	0.001

Notes: Results are expressed as mean ± SD at 6–9 months after stoma closure or 12 months after surgery in patients without a diverting stoma. P-values <0.05 are shown in bold.

Abbreviations: FSFI, Female Sexual Function Index; IMPAN, intraoperative monitoring of pelvic autonomic nerves; LAR, low anterior resection.

Table 5 Wexner score in patients with rectal cancer before and at follow-up after LAR

Evaluation of anorectal function	With IMPAN (unilateral) ten patients			With IMPAN (bilateral) 40 patients			Without IMPAN 23 patients
	Before surgery	After surgery	P-value	Before surgery	After surgery	P-value	Before surgery	After surgery	P-value
Wexner	6.500±3.95	8.10±2.60	0.193	6.63±2.69	6.85±2.24	0.544	7.09±2.86	8.48±3.34	0.071

Notes: Results are expressed as mean ± SD at 6–9 months after stoma closure or 12 months after surgery in patients without a diverting stoma.

Abbreviations: IMPAN, intraoperative monitoring of pelvic autonomic nerves; LAR, low anterior resection.