Nerve Preservation In Surgery Research Articles

Pelvic autonomic nerve preservation in rectal cancer: anatomical concept and clinical significance

Colorectal cancer is one of the most common cancers in the world, and surgery is the mainstage treatment. Urogenital and sexual dysfunction after radical resection of rectal cancer has become an important problem for patients, which seriously affects the quality of life. Some patients give up radical surgery for rectal cancer because of the concerns about sexual and urinary dysfunction. The cause of this problem is intraoperative of injury pelvic autonomic nerve. The preservation of the hypogastric nerve during the surgery is important for the male ejaculation. Pelvic splanchnic nerves are mainly responsible for the male erection. The anatomical origin, distribution, and urogenital function of these two nerves are detailed described in this article. At the same time, this article introduces the classification, key points of the operation and the evaluation of autonomic nerve preservation surgery. With the rapid development of minimally invasive surgery, performing radical surgery for rectal cancer is important, we also need to fully understand the anatomical concept of pelvic autonomic nerves, and apply modern minimally invasive surgical techniques to preserve the patient's pelvic autonomic nerves as well. It is an compulsory course and an important manifestation for the standardization of rectal cancer surgery.

A study of outcomes in patients undergoing nerve preserving surgery in colorectal cancers

Background: Colorectal cancers are third most commonly diagnosed cancer globally. Its management consist mainly of surgical intervention to achieve an oncologic cure but also to preserve function. Introduction of nerve-preserving TME technique, spares the nerve and plexus pivotal for urinary and sexual function. The study assessed the urinary and sexual function after nerve sparing colorectal surgery. Aims and objective were to check functional outcomes after nerve preservation in patient undergoing colorectal cancer surgery, in terms of urinary and sexual function.Methods: A prospective observational study conducted from January 2019 to July 2020, in the department of surgery and oncosurgery, Dr. BRAM Hospital, Raipur, Chhattisgarh.Results: According to IPSS score, post-operatively, 57.5% showed fair urinary function, 22.5% showed good urinary function and 20% showed poor urinary function at 1 month. At 3 months, 80% showed good urinary function, 15% showed fair urinary function and 5% showed poor urinary function. According to IIEF score in males, post-operatively, at 1 month, 52% had a fair score, 40% had a poor score and 8% had a good score. At 3 months, 68% had a good score, 24% had a fair score and 8% had a poor score. According to FSFI score in females, post-operatively, at 1 month, 40% had a good score, 26.6% had fair score and 33.33% had a poor score. At 3 months, 66.67% had a good score, 13.33% had a fair score and 20% had a poor score.Conclusions: Nerve preserving surgery in colorectal cancer significantly preserves urinary and sexual function.

Comprehensive anatomy of the superior hypogastric plexus and its relationship with pelvic surgery landmarks: defining the safe zone around the promontory.

Pelvic surgery carries an inherent risk of autonomic nerve injury leading to genitourinary and bowel dysfunction due to the close proximity of the superior hypogastric plexus (SHP). The aim of this study was to define the detailed anatomy of SHP and identify its relationship with the vascular landmarks and ureters for pelvic autonomic nerve-preserving surgery. A cadaveric study on the detailed anatomy of the SHP was conducted in our surgical anatomy research unit. Between 02/2019 and 10/2019, macroscopic anatomical dissections were performed on 45 fresh adult cadavers (39 male, 6 female). Distances between the SHP, major vascular structures, and other anatomical landmarks were measured. Three types of SHP morphology were observed: mesh (64.8%), single nerve (24.4%), and fiber (10.8%). SHP bifurcation was located inferior to the aortic bifurcation in all cases; however, it was observed cranial to the promontory in 80% of the cases, whereas 18% were caudally and 2% were over the promontory. The closest vessels to the left and right of the SHP bifurcation were the left common iliac vein (LCIV) (86.2%, the mean distance was 8.49 ± 7.97mm) and the right internal iliac artery (RIIA) (48.2%, mean distance was 13.4 ± 9.79mm), respectively. At SHP bifurcation level, the lateral edge of the SHP was detected on the LCIV in 22 cases and on the RIIA in 10 cases for the left and right side of the plexus, respectively. The distance between the SHP bifurcation and the ureter was 27.9mm on the right and 24.2mm on the left. The width of the left (LHN) and right hypogastric nerves (RHN) were 4.35mm and 4.62mm at 2cm below the SHP bifurcation, respectively. LHN was on the vascular structures in 13 cases, whereas RHN in only 1 case, 2cm below the SHP bifurcation. Understanding the location of the SHP, including its relationship with important anatomical landmarks, might prevent iatrogenic injury and reduce postoperative morbidity in the pelvic surgery setting.

PD10-04 CHARACTERIZING MALE ERECTILE FUNCTION AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 May 2022PD10-04 CHARACTERIZING MALE ERECTILE FUNCTION AFTER RADICAL CYSTECTOMY Benjamin Beech, Matthew Clements, Thomas Atkinson, Yuelin Li, Guido Dalbagni, Andrew Vickers, Harry Herr, S. Machele Donat, Daniel Sjoberg, Amy Tin, John Mulhall, Bruce Rapkin, and Bernard Bochner Benjamin BeechBenjamin Beech More articles by this author , Matthew ClementsMatthew Clements More articles by this author , Thomas AtkinsonThomas Atkinson More articles by this author , Yuelin LiYuelin Li More articles by this author , Guido DalbagniGuido Dalbagni More articles by this author , Andrew VickersAndrew Vickers More articles by this author , Harry HerrHarry Herr More articles by this author , S. Machele DonatS. Machele Donat More articles by this author , Daniel SjobergDaniel Sjoberg More articles by this author , Amy TinAmy Tin More articles by this author , John MulhallJohn Mulhall More articles by this author , Bruce RapkinBruce Rapkin More articles by this author , and Bernard BochnerBernard Bochner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002536.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) is understood to have a large impact on sexual function, but long-term outcomes and the impact of preoperative function have been poorly characterized. Our objective was to examine the natural history of male erectile function (EF) before and following RC. METHODS: Male patients participating in a single-center, prospective, non-randomized study of patient reported quality of life that accrued between 2008-2014 were analyzed. Patients completed the International Index of Erectile Function (IIEF) at their presurgical visit and 3, 6, 12, 18, and 24 months post-RC. Baseline differences between orthotopic neobladder (NB) and ileal conduit (IC) patients were separately analyzed based on significant surgical selection bias. Using established erectile dysfunction (ED) severity definitions for the IIEF, patients were categorized into “severe ED”, “mild-moderate ED”, or “no ED” at baseline and post-RC. We were interested in recovery of EF in patients with no preop ED and examined EF in this cohort over time. RESULTS: A total of 323 men were eligible, of which 210 completed baseline IIEF surveys. NB was performed in 115 (55%) men and IC in 95 (45%). Any attempt at bilateral or unilateral nerve sparing was performed in 50% of NB and 11% of IC patients. IC patients were older (73 vs 63 years, p <0.001), and had higher rates of severe ED (65% vs 44%, p=0.002) and lower rates of no ED (17% vs 30%, p=0.02) prior to RC. Post-RC, 84% of men reported having severe ED at 12 months and 79% at 24 months. However, among 35 men with no ED preop and NB diversion, 16.7% reported no ED at 3 months. In this group, the largest recovery occurred from 12-24 months, where rates of no ED improved from 14% to 35%. Notably, in these patients, 67% had bilateral nerve sparing and 22% underwent partial nerve sparing. Thus, in men that are potent preop, with nerve sparing, >60% report some EF, while >30% report no ED within two years. CONCLUSIONS: Men who are candidates for NB (younger, less comorbid compared to IC patients) have considerably higher baseline EF. Most recovery appeared to occur after 12 months. In highly selected patients with good baseline EF, EF recovery is possible for the majority following RC with nerve preservation surgery. Source of Funding: This work was supported by the Sidney Kimmel Center for Prostate and Urological Cancers and the NIH/NCI Cancer Center Support Grant P30 CA008748 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e184 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Beech More articles by this author Matthew Clements More articles by this author Thomas Atkinson More articles by this author Yuelin Li More articles by this author Guido Dalbagni More articles by this author Andrew Vickers More articles by this author Harry Herr More articles by this author S. Machele Donat More articles by this author Daniel Sjoberg More articles by this author Amy Tin More articles by this author John Mulhall More articles by this author Bruce Rapkin More articles by this author Bernard Bochner More articles by this author Expand All Advertisement PDF DownloadLoading ...

The management and outcome of large volume liposarcomas encasing the sciatic nerve

This paper outlines the oncological outcomes of patients with large volume liposarcomas of the posterior thigh who underwent nerve-preserving surgery utilising epineural dissection. Thirty-seven consecutive patients (group I) with a mean age of 66.2 (31-96) were surgically treated with a planned marginal resection and epineurectomy for liposarcoma with known sciatic nerve involvement between March 1997 and January 2015. The mean follow-up was 79 months (15-192). All patients underwent multidisciplinary team (MDT) pre-operative assessment and staging, with follow-up in Sarcoma Clinic. Pre-operative function was assessed by applying the Toronto extremity salvage score (TESS). Oncological and functional outcomes were recorded. In grades 1, 2, and 3, 24, 6, and 7 liposarcomas, respectively, were included with mean volume 1859 cm3. Sciatic nerve involvement extended for 13-30 cm; in one case, the nerve was abutting the tumour throughout its length. Soft tissue reconstructive surgery was required in three cases. The remainder underwent direct primary closure. Seventeen patients underwent post-operative adjuvant radiotherapy 46-60 Gy and three received chemotherapy. There was local recurrence of disease in three patients. One patient had post-radiation wound breakdown treated non-operatively. Three patients died of an unrelated cause. When compared to a cohort of 37 patients without sciatic nerve involvement (group II), there were no significant differences in local and systemic recurrence rate or post-operative survival. In conclusion, sciatic nerve-preserving surgery is both possible and safe when using a planned epineural dissection in large volume tumours encasing the sciatic nerve.

Anatomy research on Denonvilliers fascia and its significance in nerve-preservation rectal cancer surgery

Urinary and sexual dysfunctions due to intraoperative pelvic autonomic nerve injury have become the most common complications of rectal cancer surgery, seriously affecting postoperative quality of life. How to protect the nerve and urogenital function while ensuring radical resection for rectal cancer has become the focus of research. We previously carried out a series of systematic studies on Denonvilliers fascia, an important anatomical structure closely related to protection of pelvic autonomic nerve, and demonstrated the importance of Denonvilliers fascia in preservation of intraoperative pelvic autonomic nerve and protection of postoperative urogenital function from aspects of anatomy, physiology, tissue, operation practice and so on. Meanwhile, based on the interim results of our multicenter randomized controlled study, we confirmed that total mesorectal excision with preservation of Denonvilliers fascia (innovative TME, iTME) could effectively reduce the incidence of postoperative urinary and sexual dysfunctions in male patients with mid-low rectal cancer, without sacrificing oncologic outcome. In this article, combined with our research results, we review the literature on anatomy research progress of Denonvilliers fascia to demonstrate the significance and research prospect of Denonvilliers fascia in the pelvic autonomic nerve preservation surgery for rectal cancer.

Optimal Volume of the Residual Tumor to Predict Long-term Tumor Control Using Stereotactic Radiosurgery after Facial Nerve-preserving Surgery for Vestibular Schwannomas.

BackgroundIntended subtotal resection (STR) followed by adjuvant gamma knife radiosurgery (GKRS) has emerged as an effective treatment option for facial nerve (FN) preservation in vestibular schwannomas (VSs). This study aimed to identify the optimal cut-off volume of residual VS to predict favorable outcomes in terms of both tumor control and FN preservation.MethodsThis retrospective study assessed the patients who underwent adjuvant GKRS for residual VS after microsurgery. A total of 68 patients who had been followed up for ≥ 24 months after GKRS were included. Tumor progression was defined as an increase in tumor volume (TV) of ≥ 20%. House-Brackmann grades I and II were considered to indicate good FN function.ResultsThe median residual TV was 2.5 cm3 (range: 0.3–27.4). The median follow-up period after the first adjuvant GKRS was 64 months (range: 25.7–152.4). Eight (12%) patients showed tumor progression. In multivariate analyses, residual TV was associated with tumor progression (P = 0.003; hazard ratio [HR], 1.229; 95% confidence interval [CI], 1.075–1.405). A residual TV of 6.4 cm3 was identified as the cut-off volume for showing the greatest difference in progression-free survival (PFS). The 5-year PFS rates in the group with residual TVs of < 6.4 cm3 (54 patients) and that with residual TVs of ≥ 6.4 cm3 (14 patients) were 93.3% and 69.3%, respectively (P = 0.014). A good FN outcome was achieved in 57 (84%) patients. Residual TV was not associated with good FN function during the immediate postoperative period (P = 0.695; odds ratio [OR], 1.024; 95% CI, 0.908–1.156) or at the last follow-up (P = 0.755; OR, 0.980; 95% CI, 0.866–1.110).ConclusionIn this study, residual TV was associated with tumor progression in VS after adjuvant GKRS following STR. As preservation of FN function is not correlated with the extent of resection, optimal volume reduction is imperative to achieve long-term tumor control. Our findings will help surgeons predict the prognosis of residual VS after FN-preserving surgery.

The risk factors for urinary dysfunction after autonomic nerve-preserving rectal cancer surgery: a multicenter retrospective study at Yokohama Clinical Oncology Group (YCOG1307)

The aim of this retrospective study was to evaluate the frequency and risk factors of urinary dysfunction after autonomic nerve-preserving surgery for rectal cancer. This was a retrospective multiinstitution study of 1002 rectal cancer patients conducted between January 2008 and December 2012 in Yokohama Clinical Oncology Group. Patients who had preoperative urinary dysfunction or had not undergone autonomic nerve preservation surgery were excluded. Urinary dysfunction was defined as that with a Clavien-Dindo classification grade ≥ 2. Patient-, tumor-, and surgery-related variables were examined by univariate and multivariate analyses. A total of 887 patients were analyzed. Postoperative urinary dysfunction was observed in 77 patients (8.8%). A multivariate logistic analysis showed that a tumor location in lower rectum (odds ratio [OR] 2.16; 95% confidence interval [CI] 1.15-3.71; p = 0.02), tumor diameter ≥ 40mm (OR 2.07; 95% CI 1.19-4.44; p < 0.01), operation time ≥ 240min (OR 2.07; 95% CI 1.19-4.44; p < 0.01), blood loss ≥ 300ml (OR 2.35; 95% CI 1.12-3.84; p = 0.02), and diabetes (OR 3.26; 95% CI 1.80-5.89; p < 0.01) were independent risk factors of urinary dysfunction. The incidence of urinary dysfunction exceeded 20% in patients with 3 preoperative predictors (tumor location, tumor diameter, diabetes). This result demonstrated that high-risk patients with more than two risk factors should be informed of the risk of urinary dysfunction. UMIN000033688.

Panel Discussion 4 “Recurrent Laryngeal Nerve—Preservation Surgery and Regeneration-targeted Research” —Introduction

Panel Discussion 4 “Recurrent Laryngeal Nerve—Preservation Surgery and Regeneration-targeted Research” —Introduction

Effectiveness of preoperative facial nerve diffusion tensor imaging tractography for preservation of facial nerve function in surgery for large vestibular schwannomas: Results of a prospective randomized study.

The goal of surgery in case of a large vestibular schwannoma is complete excision of tumor and preservation of facial nerve function. The identification and preservation of facial nerve is very difficult during surgery, particularly in case of large tumors. This prospective randomized study was conducted to find out the effectiveness of preoperative facial nerve diffusion tensor imaging tractography (DTI) to predict location of the nerve and preservation of facial nerve function in surgery for large vestibular schwannomas. In this prospective randomized study, we recruited 100 patients with a large vestibular schwannoma(> 3cm). After initial scrutiny, 94 patients were randomized based on a computer generated chart. In group I, preoperative DTI was done and the operating surgeon was informed about the position of facial nerve preoperatively. In group II, DTI was not done. The facial nerve preservation rates and clinical outcome at follow up was compared between the two groups. Out of 94 patients, there were 47 patients in group I (DTI group) and 47 patients in group II (Non DTI group). In DTI group, 40 patients were left for comparison after the exclusion criteria was applied. Preoperative DTI predicted that the facial nerve position was concordant with its intraoperative position in 39 patients (97.5% concordance). Facial nerve preservation rates were statistically significant in group I (DTI group) (P value = 0.002). The study establishes the role of preoperative DTI tractography for better facial nerve preservation in surgery for large vestibular schwannomas (>3 cm).

Complications associated with carotid body tumor excision.

This study aims to evaluate associated complications of carotid tumor excisions and outcomes. Between January 2013 and April 2016, a total of 29 patients (2 males, 27 females; mean age 55.2±4.4 years; range, 17 to 76 years) were operated with the preliminary diagnosis of a carotid body tumor. According to the Shamblin classification of carotid body tumors, 12 patients were type 1, 13 patients were type 2, and four patients were type 3. Main symptoms were dizziness, pain in the neck area, tinnitus, and headache. Headache was the most common symptom among them. Neurological and surgical complications developed in 10 patients (34.4%). Of operated patients, dysphagia developed in three (8.7%), facial hemiparesis in two (6.8%), hemorrhage in two (6.8%), hematoma-related respiratory distress in one (3.4%), left hemiparesis in one (3.4%), and transient bradycardia in one (3.4%). The patient who had respiratory distress associated with bleeding following extubation was reoperated. In the patients with facial and left hemiparesis, paresis was transient. Dysphagia also resolved in the subsequent follow-up outpatient visits. None of the patients experienced a permanent complication. Surgical excision is the most appropriate choice of treatment in carotid body tumors, and postoperative complications can be minimized through careful dissections and retractions. A special attention should be paid to nerve-preserving surgery.

Usefulness of supraclavicular nerve preservation in surgery of clavicle shaft fractures

Usefulness of supraclavicular nerve preservation in surgery of clavicle shaft fractures

Особенности нервосберегающих операций при новообразованиях околоушно-жевательной области в детском и подростковом возрасте

A retrospective analysis was made in 40 patients who underwent the examination and treatment in Dmitry Rogachev National Research Center from January 2014 to July 2017. Median age at the time of surgery was 7 years (range 4 m.–18 years). All patients underwent a comprehensive examination to determine the operation type. Precision neurolysis and facial nerve preservation were carried out in all cases of the absence of macroscopic invasion of the tumor into nerve. Facial nerve monitoring during parotidectomy was used in 45% (n = 18) patients. Follow-up period varied between 3 months and 3.5 years. There was no recurrences. Frequency of immediate postoperative facial nerve paresis was 27.5% (n = 11), from which only 2,5% (n = 1) was permanent paresis. Type of surgery was the only one risk factor of postoperative facial nerve dysfunction. Thus, age, reoperation, closely spaced tumor, operating time and malignant tumors were not risk factors of intraoperative facial nerve injury. Nerve-preserving surgery showed its effectiveness, allowing the functional state of the facial nerve to be preserved without incidental injury to the radical removal of the neoplasm of the parotid chewing area especially important in childhood and adolescence.

The rate of facial nerve dysfunction and time to recovery after intraparotid and extraparotid facial nerve exposure and protection in head and neck cutaneous tumor surgery.

Most patients with head and neck skin tumors present with normal facial nerve function. A common treatment strategy for these patients is facial nerve preservation surgery, although the degree to which the nerve is successfully preserved is still unclear. Data on the incidence and recovery of facial nerve dysfunction are woefully lacking in the field of dermato-oncology. In 23 patients with normal preoperative facial nerve function, we retrospectively reviewed twenty-six head and neck surgical interventions that included facial nerve exposure and protection, focusing particularly on the differences in outcome between intraparotid and extraparotid exposure of the facial nerve branches. Eleven of the 26 cases (42.4%) developed transient paresis, but only one (3.8%) developed permanent paresis. Of 41 dissected facial nerve branches, 14 developed transient paresis (34.1%) and one, a marginal mandibular branch, developed permanent paresis (2.4%). The branches most susceptible to developing paresis were the temporal (4/6 branches, 66.7%) and marginal mandibular branches (8/17 branches, 47.1%). Although the rate of paresis was higher, and ensuing recovery period slightly longer in the extraparotid dissection group compared to the intraparotid dissection group, there were no statistically significant differences between the two groups. The extraparotid and intraparotid rates of paresis were 48% (11/23 branches) and 21.1% (4/19 branches), respectively, P=0.139; and the average recovery periods were 10.3 and 9.3weeks, respectively, P=0.64. The functional outcome, regardless of the different sites of facial nerve exposure, was almost always either complete facial nerve sparing or transient dysfunction that resolved within 6months.

Functional Nerve Preservation in Extracranial Head and Neck Schwannoma Surgery.

A schwannoma is an uncommon, benign neurogenic tumor of Schwann cells. Tumor enucleation is the recommended surgical method to preserve function of the original nerve, although enucleation does not guarantee completely intact nerve function after the operation. To establish a strategy for functional preservation in extracranial head and neck schwannoma treatment by using an electromyographic (EMG) system during tumor resection. A retrospective cohort study was conducted of 15 patients who underwent surgery for removal of schwannoma tumors between April 1, 2006, and March 31, 2015, at an academic tertiary referral center. Data analysis was conducted from April 3, 2006, to September 15, 2015. Neurogenic tumors were diagnosed according to preoperative findings, and during surgery tumors were exposed and given EMG-controlled electrical stimulation to analyze their origins. In motor nerve cases, the electrical activity of the muscle was measured and recorded by EMG. The tumor was then enucleated by incision along tumor fibers mapped using EMG stimulation. If a nerve bundle was visible, we incised along there and enucleated the tumor. A strategy using electrical stimulation to improve preservation of nerve function in extracranial head and neck schwannoma operations. Frequency and duration of postoperative neurologic complications associated with functional preservation surgery with tumor enucleation was evaluated using EMG monitoring according to tumor origin. Of the 15 patients with extracranial schwannoma, 9 (60%) were women (mean [SD] age, 36.3 [15.3] years). All 15 patients underwent surgery using a transcervical approach. The most common nerves of origin were the vagus nerve and the sympathetic chain. In sensory or sympathetic nerve cases, the EMG response was absent. Two of 5 patients with vagus schwannoma had postoperative temporary vocal nerve palsy. These symptoms showed improvement after 1 year. There was no tumor recurrence during the follow-up period in any patient. The strategy used here demonstrated a method of diagnosis and nerve preservation surgery for extracranial schwannomas. Nerve functionality was preserved in all vagus schwannoma cases. However, preservation of nerve function in sympathetic nerve schwannoma cases remains problematic and needs further investigation.

Functional Outcome of the Facial Nerve After Surgery for Vestibular Schwannoma: Prediction of Acceptable Long-Term Facial Nerve Function Based on Immediate Postoperative Facial Palsy

To examine the relationship between immediate postoperative facial palsy and long-term facial palsy and identify a treatment strategy for vestibular schwannoma considering long-term outcomes of facial nerve function and tumor control. Patients (N= 385) who underwent surgery in a single institution were reviewed retrospectively; 12 patients with neurofibromatosis, 6 with preoperative radiosurgery, and 14 with multiple surgeries were excluded. The generalized estimating equation method was used to show the correlation between immediate and later postoperative facial palsy and to identify the cutoff grade of immediate postoperative facial palsy. The tumor control rates for 1 year, 3 years, and 5 years were 88.7%, 83.9%, and 80.0%. Preservation of facial function above House-Brackmann (H-B) grades 1 and 2 was achieved in 47.9% of patients immediately postoperatively, in 50.1% after 1 month, and in 74.5% after >2 years. The immediate postoperative facial palsy grade showed a statistically significant relationship with the facial palsy grade on long-term follow-up (P < 0.001). H-B grade 3 immediate postoperative facial palsy was identified as the cutoff grade that showed the most significant relationship between the grade of immediate postoperative facial palsy and the grades above the cutoff (H-B grade 1-3) on long-term follow-up (P < 0.001). H-B grade of immediate postoperative facial palsy can predict facial palsy at long-term follow-up. H-B grade 3 immediate postoperative facial palsy is the lowest tolerable grade that guarantees functional improvement on long-term follow-up. Planned facial nerve preservation surgery followed by radiosurgery is thought to be optimal treatment in patients with vestibular schwannoma for both tumor control and facial nerve function.

Male urinary and sexual function after robotic pelvic autonomic nerve-preserving surgery for rectal cancer.

Urinary and sexual dysfunction is the potential complication of rectal cancer surgery. The aim of this study was to evaluate the urinary and sexual function in male patients with robotic surgery for rectal cancer. This prospective study included 137 of the 336 male patients who underwent surgery for rectal cancer. Urinary and male sexual function was studied by means of a questionnaire based on the International Prostatic Symptom Score and International Index of Erectile Function. All data were collected before surgery and 12 months after surgery. Patients who underwent robotic surgery had significantly decreased incidence of partial or complete erectile dysfunction and sexual dysfunction than patients with laparoscopic surgery. The pre- and post-operative total IPSS scores in patients with robotic surgery were significantly less than that with laparoscopic surgeries. Robotic surgery shows distinct advantages in protecting the pelvic autonomic nerves and relieving post-operative sexual dysfunction.

Efficacy and safety of udenafil for the treatment of erectile dysfunction after total mesorectal excision of rectal cancer: A randomized, double-blind, placebo-controlled trial

Nerve-preserving surgery has been provided for patients with rectal cancer; however, sexual dysfunction remains a common complication of rectal cancer surgery. This study explored the efficacy of udenafil to treat erectile dysfunction in male patients who underwent total mesorectal excision (TME) for rectal cancer. We conducted a randomized, double-blind, placebo-controlled clinical trial involving 80 male patients who had decreased International Index of Erectile Function-5 (IIEF-5) scores after TME for rectal cancer. Patients received placebo (50 mg) or udenafil (50 mg) for 12 weeks. The primary outcome variable was the change in IIEF-5 scores. The secondary outcome variables were Sexual Encounter Profile (SEP) questions 2 (Q2) and 3 (Q3), and the Global Assessment Question (GAQ). Baseline IIEF-5 scores, SEP Q2 and Q3 responses, and spontaneous erection rates were consistent in both groups. At the end of treatment, the change in IIEF-5 scores from the baseline was significantly higher in the udenafil group than it was in the placebo group (mean IIEF-5 score, 4.8 ± 4.0 vs 2.0 ± 1.7; P < .05). Responses to SEP Q2, SEP Q3, and GAQ were significantly higher in the udenafil group than they were in the placebo group (SEP Q2, P = .025; SEP Q3, P = .044; GAQ, P < .001). Treatment-related adverse events (n = 4) were all mild in severity. Oral udenafil was deemed safe and effective for the treatment of erectile dysfunction in patients who underwent TME for rectal cancer.

Intraoperative Vagus Nerve Monitoring: A Transnasal Technique during Skull Base Surgery.

Objectives Intraoperative vagus nerve monitoring during skull base surgery has been reported with the use of an oral nerve monitoring endotracheal tube. However, the intraoral presence of an endotracheal tube can limit exposure by its location in the operative field during transfacial approaches and by limiting superior mobilization of the mandible during transcervical approaches. We describe a transnasal vagus nerve monitoring technique. Design and Participants Ten patients underwent open skull base surgery. Surgical approaches included transcervical (five), transfacial/maxillary swing (three), and double mandibular osteotomy (two). The vagus nerve was identified, stimulated, and monitored in all cases. Main Outcome Measures Intraoperative nerve stimulation, pre- and postoperative vagus nerve function through the use of flexible laryngoscopy in conjunction with assessment of subjective symptoms of hoarseness, voice change, and swallowing difficulty. Results Three patients had extensive involvement of the nerve by tumor with complete postoperative nerve deficit, one patient had a transient deficit following dissection of tumor off of nerve with resolution, and the remaining patients had nerve preservation. One patient experienced minor epistaxis during monitor tube placement that was managed conservatively. Conclusions Transnasal vagal nerve monitoring is a simple method that allows for intraoperative monitoring during nerve preservation surgery without limiting surgical exposure.

Facial nerve preservation surgery for koos grade 3 and 4 vestibular schwannomas.

Facial nerve preservation surgery for large vestibular schwannomas is a novel strategy for maintaining normal nerve function by allowing residual tumor adherent to this nerve or root-entry zone. To report, in a retrospective study, outcomes for large Koos grade 3 and 4 vestibular schwannomas. After surgical treatment for vestibular schwannomas in 52 patients (2004-2013), outcomes included extent of resection, postoperative hearing, and facial nerve function. Extent of resection defined as gross total, near total, or subtotal were 7 (39%), 3 (17%), and 8 (44%) in 18 patients after retrosigmoid approaches, respectively, and 10 (29.5%), 9 (26.5%), and 15 (44%) for 34 patients after translabyrinthine approaches, respectively. Hearing was preserved in 1 (20%) of 5 gross total, 0 of 2 near-total, and 1 (33%) of 3 subtotal resections. Good long-term facial nerve function (House-Brackmann grades of I and II) was achieved in 16 of 17 gross total (94%), 11 of 12 near-total (92%), and 21 of 23 subtotal (91%) resections. Long-term tumor control was 100% for gross total, 92% for near-total, and 83% for subtotal resections. Postoperative radiation therapy was delivered to 9 subtotal resection patients and 1 near-total resection patient. Follow-up averaged 33 months. Our findings support facial nerve preservation surgery in becoming the new standard for acoustic neuroma treatment. Maximizing resection and close postoperative radiographic follow-up enable early identification of tumors that will progress to radiosurgical treatment. This sequential approach can lead to combined optimal facial nerve function and effective tumor control rates.