Selective Pelvic Autonomic Nerve Stimulation with Simultaneous Intraoperative Monitoring of Internal Anal Sphincter and Bladder Innervation

2011 ◽  
Vol 46 (3) ◽  
pp. 133-138 ◽  
Author(s):  
W. Kneist ◽  
D.W. Kauff ◽  
K.P. Koch ◽  
I. Schmidtmann ◽  
A. Heimann ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Nerve Stimulation ◽  
Internal Anal Sphincter ◽  
Intraoperative Monitoring ◽  
Autonomic Nerve ◽  
Pelvic Autonomic Nerve

Surface Electromyography Reliably Records Electrophysiologically Evoked Internal Anal Sphincter Activity: A More Minimally Invasive Approach for Monitoring Extrinsic Innervation

2016 ◽  
Vol 57 (1-2) ◽  
pp. 81-88 ◽  
Author(s):  
Daniel W. Kauff ◽  
Nicolas Wachter ◽  
Axel Heimann ◽  
Thilo B. Krüger ◽  
Klaus-Peter Hoffmann ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Autonomic Nerve ◽  
Pelvic Surgery ◽  
Transanal Total Mesorectal Excision ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Anterior Rectal Resection ◽  
Extrinsic Innervation

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.

Inhibitory effect of CO on internal anal sphincter: heme oxygenase inhibitor inhibits NANC relaxation

1993 ◽  
Vol 265 (4) ◽  
pp. G799-G804 ◽  
Author(s):  
S. Rattan ◽  
S. Chakder
Keyword(s):  
Smooth Muscle ◽  
Anal Sphincter ◽  
Heme Oxygenase ◽  
Nerve Stimulation ◽  
Internal Anal Sphincter ◽  
Direct Action ◽  
Second Messengers ◽  
Protoporphyrin Ix ◽  
Zinc Protoporphyrin ◽  
Before And After

We examined the effect and role of CO in opossum internal anal sphincter (IAS) relaxation in response to nonadrenergic noncholinergic (NANC) nerve stimulation. Effects of NANC nerve stimulation on the IAS tension and second messengers (cAMP and cGMP) were examined before and after the selective heme oxygenase (HO) inhibitor zinc protoporphyrin IX (Zn PP-IX). The HO activity of the IAS smooth muscle was determined before and after NANC nerve stimulation. CO caused a concentration-dependent and tetrodotoxin-resistant fall in the resting tension of the IAS. The direct action of CO was confirmed by its relaxant action on the isolated smooth muscle cells. Furthermore, CO caused an increase in the tissue cGMP levels comparable to that observed with nerve stimulation. Zn PP-IX caused suppression of IAS relaxation caused by NANC nerve stimulation and vasoactive intestinal polypeptide (VIP) but not by peptide histidine-isoleucine and suppression of the increase in cGMP in response to NANC nerve stimulation. Zn PP-IX had no significant effect on the IAS responses to CO, nitric oxide (NO), and the beta-adrenoceptor agonist isoproterenol. The IAS responses to CO were not modified by the NO synthase inhibitor NG-nitro-L-arginine. Significant HO activity was detected in the IAS, which increased further in response to NANC nerve stimulation and VIP. The direct relaxant actions of CO and the suppression of NANC-mediated relaxation of the IAS by the HO inhibitor suggest the involvement of CO in the neurally mediated IAS relaxation.

Sign in / Sign up

Export Citation Format

Share Document