Anatomical localization and real-time neuro-electrophysiological monitoring of pelvic organ nerves during robot-assisted laparoscopic radical prostatectomy (report of 11 cases)
LYU Xiangjun1, AO Liyan1, JIA Zhuo1, WANG Baojun1, REN Changhao1, CHEN Ke1, XU Yunlai1, WU Yangyang1, ZHANG Yongjie1, MA Xin1, ZHANG Xu1
1Department of Urology, Chinese PLA General Hospital, Beijing 100853, China
Abstract：Objective： To explore the clinical significance of anatomical localization and real-time neuro-electrophysiological monitoring of pelvic organ nerves to preservation of pelvic organ nerves in robot-assisted laparoscopic radical prostatectomy （RALP）. Methods： A total of 11 patients with prostate cancer who were treated at the PLA General Hospital from January 2021 to July 2021 with normal erectile function,urinary function,anorectal function before operation were selected to undergo neuro-electrophysiological monitoring of pelvic organ nerves during RALP. During the operation, the pelvic organ nerves （superior hypogastric plexus, hypogastric nerve, pelvic plexus and their branches） were dissected and stimulated. After electrical stimulation, the changes of the electrophysiological waveforms of the effector organs （the Corpus cavernosum, urethral sphincter and ani sphincter） were recorded. Meanwhile, the operation duration, blood lost during operation, the time of the uric catheter removal, the situation of immediate and long-term continence, the time of recovery of ventilation and defecation, the scores of postoperative erectile function, urinary function, anorectal function after the operation were recorded. Results： All 11 patients underwent surgery successfully. For nerves preservation, 5 patients underwent bilateral extrafascial technique, 1 patient was given left interfascial right extrafascial technique, and 4 patients were subjected to bilateral intrafascial technique, 1 case received left intrafascial and right interfascial technique. The average age was （61.90 ± 4.70） years, the average body mass index （BMI） was （26.09 ± 3.91） kg/m², the average operation duration was （193.20 ± 42.97） min, the average intraoperative blood loss was （109.10 ± 43.69） mL, and the postoperative time of uric catheter removal was （14.82 ± 1.78） days. Four patients with bilateral intrafascial surgery recovered immediate continence well and their incontinence score （ICIQ-SF score） ≤4. The IIEF-5 and EHS scores in 3 of these patients decreased significantly 6 months after surgery, and the rest one had good recovery of erectile, urinary continence and anorectal function whose electrophysiological waveforms had significant change after stimulation during operation. Conclusions： Anatomical localization and real-time neuro-electrophysiological monitoring of pelvic organ nerves during RALP is safe and feasible with the nerve electric monitoring system. The electromyography waveform of real-time nerve monitoring during operation is correlated with the recovery of erectile function, urinary function, anorectal function, which provides a promising method for predicting the preservation and recovery of these functions after operation.
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