The efficacy of a nerve stimulator (Cavermap®) to enhance autonomic nerve identification and confirm nerve preservation during total mesorectal excision

Giovanna M. Da Silva, Oded Zmora, Lars Börjesson, Nelly Mizhari, Norma Daniel, Farah Khandwala, Jonathan Efron, Eric G. Weiss, Juan J. Nogueras, Anthony M. Vernava, Steven D. Wexner

Research output: Contribution to journalArticle

Abstract

PURPOSE: Sexual dysfunction after total mesorectal excision may be caused by injury to the autonomic nerves. During surgery, nerve identification is not always achieved, and, to date, there has been no method to objectively confirm nerve preservation. The aim of this study was to assess the efficacy of a nerve-stimulating device (CaverMap®) to assist in the intraoperative identification of the autonomic nerves during total mesorectal excision, and objectively confirm nerve preservation after proctectomy is completed. PATIENTS AND METHODS: Sexually active consecutive male patients undergoing total mesorectal excision were prospectively enrolled in this study. During pelvic dissection, the surgeon attempted to localize the hypogastric and cavernous nerves. Cavermap® was used to confirm these findings and to facilitate the identification in cases of uncertainty. At the completion of proctectomy, the nerves were restimulated to ensure preservation. Factors that could affect the surgeon's ability to localize the nerves and Cavermap® to confirm this were evaluated. RESULTS: Twenty-nine male patients with a median age of 58 years were enrolled in this study. An attempt to visualize the hypogastric nerves during dissection was made in 26 patients; the surgeon was able to identify the nerves in 19 (73 percent) patients. Cavermap® successfully identified the nerves in six of the seven remaining patients, and failed to identify them in only one case. An attempt to localize the cavernous nerves during dissection was made in 13 patients, of which localization was successful in 8 (61.5 percent) patients. Cavermap® improved the identification rate in four of the remaining five patients. After proctectomy, Cavermap® successfully confirmed the preservation of both hypogastric and cavernous nerves in 27 of 29 (93 percent) patients. A history of previous surgery statistically correlated with failure to identify the hypogastric nerves by the surgeon (P = 0.005). There were no adverse events related to use of the device. CONCLUSION: Cavermap® may be a useful tool to facilitate identification of the pelvic autonomic nerves during total mesorectal excision and to objectively confirm nerve preservation.

Original languageEnglish (US)
Pages (from-to)2032-2038
Number of pages7
JournalDiseases of the Colon and Rectum
Volume47
Issue number12
DOIs
StatePublished - Dec 2004
Externally publishedYes

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Autonomic Pathways
Dissection
Equipment and Supplies
Uncertainty

Keywords

  • Impotence
  • Nerve stimulator
  • Parasympathetic nerves
  • Rectal carcinoma
  • Retrograde ejaculation
  • Suprapubic nerves
  • Total mesorectal excision

ASJC Scopus subject areas

  • Gastroenterology

Cite this

The efficacy of a nerve stimulator (Cavermap®) to enhance autonomic nerve identification and confirm nerve preservation during total mesorectal excision. / Da Silva, Giovanna M.; Zmora, Oded; Börjesson, Lars; Mizhari, Nelly; Daniel, Norma; Khandwala, Farah; Efron, Jonathan; Weiss, Eric G.; Nogueras, Juan J.; Vernava, Anthony M.; Wexner, Steven D.

In: Diseases of the Colon and Rectum, Vol. 47, No. 12, 12.2004, p. 2032-2038.

Research output: Contribution to journalArticle

Da Silva, GM, Zmora, O, Börjesson, L, Mizhari, N, Daniel, N, Khandwala, F, Efron, J, Weiss, EG, Nogueras, JJ, Vernava, AM & Wexner, SD 2004, 'The efficacy of a nerve stimulator (Cavermap®) to enhance autonomic nerve identification and confirm nerve preservation during total mesorectal excision', Diseases of the Colon and Rectum, vol. 47, no. 12, pp. 2032-2038. https://doi.org/10.1007/s10350-004-0718-5
Da Silva, Giovanna M. ; Zmora, Oded ; Börjesson, Lars ; Mizhari, Nelly ; Daniel, Norma ; Khandwala, Farah ; Efron, Jonathan ; Weiss, Eric G. ; Nogueras, Juan J. ; Vernava, Anthony M. ; Wexner, Steven D. / The efficacy of a nerve stimulator (Cavermap®) to enhance autonomic nerve identification and confirm nerve preservation during total mesorectal excision. In: Diseases of the Colon and Rectum. 2004 ; Vol. 47, No. 12. pp. 2032-2038.
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abstract = "PURPOSE: Sexual dysfunction after total mesorectal excision may be caused by injury to the autonomic nerves. During surgery, nerve identification is not always achieved, and, to date, there has been no method to objectively confirm nerve preservation. The aim of this study was to assess the efficacy of a nerve-stimulating device (CaverMap{\circledR}) to assist in the intraoperative identification of the autonomic nerves during total mesorectal excision, and objectively confirm nerve preservation after proctectomy is completed. PATIENTS AND METHODS: Sexually active consecutive male patients undergoing total mesorectal excision were prospectively enrolled in this study. During pelvic dissection, the surgeon attempted to localize the hypogastric and cavernous nerves. Cavermap{\circledR} was used to confirm these findings and to facilitate the identification in cases of uncertainty. At the completion of proctectomy, the nerves were restimulated to ensure preservation. Factors that could affect the surgeon's ability to localize the nerves and Cavermap{\circledR} to confirm this were evaluated. RESULTS: Twenty-nine male patients with a median age of 58 years were enrolled in this study. An attempt to visualize the hypogastric nerves during dissection was made in 26 patients; the surgeon was able to identify the nerves in 19 (73 percent) patients. Cavermap{\circledR} successfully identified the nerves in six of the seven remaining patients, and failed to identify them in only one case. An attempt to localize the cavernous nerves during dissection was made in 13 patients, of which localization was successful in 8 (61.5 percent) patients. Cavermap{\circledR} improved the identification rate in four of the remaining five patients. After proctectomy, Cavermap{\circledR} successfully confirmed the preservation of both hypogastric and cavernous nerves in 27 of 29 (93 percent) patients. A history of previous surgery statistically correlated with failure to identify the hypogastric nerves by the surgeon (P = 0.005). There were no adverse events related to use of the device. CONCLUSION: Cavermap{\circledR} may be a useful tool to facilitate identification of the pelvic autonomic nerves during total mesorectal excision and to objectively confirm nerve preservation.",
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AU - Da Silva, Giovanna M.

AU - Zmora, Oded

AU - Börjesson, Lars

AU - Mizhari, Nelly

AU - Daniel, Norma

AU - Khandwala, Farah

AU - Efron, Jonathan

AU - Weiss, Eric G.

AU - Nogueras, Juan J.

AU - Vernava, Anthony M.

AU - Wexner, Steven D.

PY - 2004/12

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N2 - PURPOSE: Sexual dysfunction after total mesorectal excision may be caused by injury to the autonomic nerves. During surgery, nerve identification is not always achieved, and, to date, there has been no method to objectively confirm nerve preservation. The aim of this study was to assess the efficacy of a nerve-stimulating device (CaverMap®) to assist in the intraoperative identification of the autonomic nerves during total mesorectal excision, and objectively confirm nerve preservation after proctectomy is completed. PATIENTS AND METHODS: Sexually active consecutive male patients undergoing total mesorectal excision were prospectively enrolled in this study. During pelvic dissection, the surgeon attempted to localize the hypogastric and cavernous nerves. Cavermap® was used to confirm these findings and to facilitate the identification in cases of uncertainty. At the completion of proctectomy, the nerves were restimulated to ensure preservation. Factors that could affect the surgeon's ability to localize the nerves and Cavermap® to confirm this were evaluated. RESULTS: Twenty-nine male patients with a median age of 58 years were enrolled in this study. An attempt to visualize the hypogastric nerves during dissection was made in 26 patients; the surgeon was able to identify the nerves in 19 (73 percent) patients. Cavermap® successfully identified the nerves in six of the seven remaining patients, and failed to identify them in only one case. An attempt to localize the cavernous nerves during dissection was made in 13 patients, of which localization was successful in 8 (61.5 percent) patients. Cavermap® improved the identification rate in four of the remaining five patients. After proctectomy, Cavermap® successfully confirmed the preservation of both hypogastric and cavernous nerves in 27 of 29 (93 percent) patients. A history of previous surgery statistically correlated with failure to identify the hypogastric nerves by the surgeon (P = 0.005). There were no adverse events related to use of the device. CONCLUSION: Cavermap® may be a useful tool to facilitate identification of the pelvic autonomic nerves during total mesorectal excision and to objectively confirm nerve preservation.

AB - PURPOSE: Sexual dysfunction after total mesorectal excision may be caused by injury to the autonomic nerves. During surgery, nerve identification is not always achieved, and, to date, there has been no method to objectively confirm nerve preservation. The aim of this study was to assess the efficacy of a nerve-stimulating device (CaverMap®) to assist in the intraoperative identification of the autonomic nerves during total mesorectal excision, and objectively confirm nerve preservation after proctectomy is completed. PATIENTS AND METHODS: Sexually active consecutive male patients undergoing total mesorectal excision were prospectively enrolled in this study. During pelvic dissection, the surgeon attempted to localize the hypogastric and cavernous nerves. Cavermap® was used to confirm these findings and to facilitate the identification in cases of uncertainty. At the completion of proctectomy, the nerves were restimulated to ensure preservation. Factors that could affect the surgeon's ability to localize the nerves and Cavermap® to confirm this were evaluated. RESULTS: Twenty-nine male patients with a median age of 58 years were enrolled in this study. An attempt to visualize the hypogastric nerves during dissection was made in 26 patients; the surgeon was able to identify the nerves in 19 (73 percent) patients. Cavermap® successfully identified the nerves in six of the seven remaining patients, and failed to identify them in only one case. An attempt to localize the cavernous nerves during dissection was made in 13 patients, of which localization was successful in 8 (61.5 percent) patients. Cavermap® improved the identification rate in four of the remaining five patients. After proctectomy, Cavermap® successfully confirmed the preservation of both hypogastric and cavernous nerves in 27 of 29 (93 percent) patients. A history of previous surgery statistically correlated with failure to identify the hypogastric nerves by the surgeon (P = 0.005). There were no adverse events related to use of the device. CONCLUSION: Cavermap® may be a useful tool to facilitate identification of the pelvic autonomic nerves during total mesorectal excision and to objectively confirm nerve preservation.

KW - Impotence

KW - Nerve stimulator

KW - Parasympathetic nerves

KW - Rectal carcinoma

KW - Retrograde ejaculation

KW - Suprapubic nerves

KW - Total mesorectal excision

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