Online signalprocessing of internal anal sphincter activity under pelvic autonomic nerve stimulation: apromising bio-sensing technology to improve surgical outcome in rectal cancer patients: LTP07

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Aim:Pelvic autonomic nerve monitoring may decrease postoperative uro-genital and ano-rectal dysfunction and maintain patients' quality of life. The aim of this animal study was to develop a new neuro-monitoring system to verify nerve function during the surgicalprocedure.Method:Fifteen pigs underwent low anterior rectal resection with pelvic autonomic nervepreservation (PANP). Neuro-monitoring was performed under autonomic nerve stimulation with observation of electromyographic signals of the internal anal sphincter (IAS) and bladder manometry.Results:For reliable illustration of IAS activity and simultaneous observation of bladder manometry a neuro-monitoring device was adapted by newly developed hardware and software components. Band pass filters were implemented as the IAS frequency spectrum during stimulation was found to be mainly in the range of 5-20 Hz. In 10preliminary experiments postoperative offline signalprocessing was performed and demonstrated significant increase of neuro-monitoring signals representing IAS activity under stimulation. In five consecutive experiments intra-operative online signalprocessing was realized [1.22 vs (95 % CI: 0.94;1.52) vs 5.41 vs (95 % CI: 3.58;7.24)], (P < 0.001). Mean increase in intra-vesicalpressure was 6.2 cm H2O (95% CI: 5.2; 7.2). (videopresentation)Conclusion:This newly developed neuro-monitoring system offers potential for improvement of PANP and functional results (BMBF, Grant number 01EZ0722).

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