Background: Pelvic intraoperative neuromonitoring during nerve-sparing robot-assisted total mesorectal excision (RTME) is feasible. However, visual separation of the neuromonitoring process from the surgeon console interrupts the workflow and limits the usefulness of available information as the procedure progresses. Since the robotic surgical system provides multi-image views in the surgeon console, the aim of this study was to integrate cystomanometry and internal anal sphincter electromyography signals to aid the robotic surgeon in his/her nerve-sparing technique.
Methods: We prospectively investigated 5 consecutive patients (1 male, 4 females) who underwent RTME for rectal cancer at our institution in 2017. The robotic surgery was performed using the da Vinci Xi combined with pelvic intraoperative neuromapping with real-time electromyography and cystomanometry signal transmission by multi-image view during RTME.
Results: The adapted two-dimensional pelvic intraoperative neuromonitoring imaging successfully simulcasted to the surgeon console view in all 5 cases. The technical note is complemented by an intraoperative video.
Conclusions: This report demonstrates the technical feasibility of an improved neuromonitoring process during nerve-sparing RTME. Robotic neuromapping can be fully visualized from the surgeon console.
Keywords: Autonomic pathways; Neuromonitoring; Rectal cancer; Robotic surgical procedures.