the art of neuromonitoring

in rectal surgery


Pelvic neuromonitoring

Intraoperative neuromonitoring (IOM) has become a valuable tool for the identification and preservation of nerves over the past two decades. Sensitivity for the need to preserve motor and sensory nerve function has increased significantly, especially in endocrine surgery such as thyroid procedures, but also in vascular, ENT, and maxillofacial surgery.

The use of intraoperative neuromonitoring in the area of the small pelvis to protect pelvic nerves (pIOM) has been a research topic for numerous international working groups for several years. A number of trials were able to demonstrate that the function of autonomous nerves can be recorded with measuring technology based on electrical stimulation and the associated induced rise of pressure in the bladder. Similarly, intraoperative neuromonitoring, with a few modifications and an EMG measuring device, makes it feasible to acquire increased amplitudes at the internal anal sphincter with EMG after electrical stimulation of the autonomous pelvic nerves.

Our AVALANCHE® SI devices already have such capabilities, which we are testing within the scope of our research work.



D. W. Kauff & O. Kempski & K. P. Koch & S. Huppert & K. P. Hoffmann & H. Lang & W. Kneist

Continuous intraoperative monitoring of autonomic nerves during low anterior rectal resection: an innovative approach for observation of functional nerve integrity in pelvic surgery. Langenbecks Arch Surg (2012) 397:787-792

Takenaka A, Tewari A, Hara R, Leung RA, Kurokawa K, Murakami G, Fujisawa M

Pelvic autonomic nerve mapping around the prostate by intraoperative electrical stimulation with simultaneous measurement of intracavernous and intraurethral pressure. J Urol (2007) 177:225-229

Fields of application