Novel multi-image view for neuromapping meets the needs of the robotic surgeon



Pelvic intraoperative neuromonitoring during nerve-sparing robot-assisted total mesorectal excision (RTME) is feasible. However, visual separation of the neuromonitoring process from the surgeon console interrupts the workflow and limits the usefulness of available information as the procedure progresses. Since the robotic surgical system provides multi-image views in the surgeon console, the aim of this study was to integrate cystomanometry and internal anal sphincter electromyography signals to aid the robotic surgeon in his/her nerve-sparing technique.


We prospectively investigated 5 consecutive patients (1 male, 4 females) who underwent RTME for rectal cancer at our institution in 2017. The robotic surgery was performed using the da Vinci Xi combined with pelvic intraoperative neuromapping with real-time electromyography and cystomanometry signal transmission by multi-image view during RTME.


The adapted two-dimensional pelvic intraoperative neuromonitoring imaging successfully simulcasted to the surgeon console view in all 5 cases. The technical note is complemented by an intraoperative video.


This report demonstrates the technical feasibility of an improved neuromonitoring process during nerve-sparing RTME. Robotic neuromapping can be fully visualized from the surgeon console.

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We would like to thank Dipl.-Ing. K. Somerlik-Fuchs (inomed Medizintechnik GmbH, Emmendingen, Germany) and Dr. med. T. Schlick (Intuitive Surgical, Sunnyvale, CA, USA) for commitment and technical support as well as Monia Passalacqua (Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Germany) for participation in the video.

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Correspondence to Werner Kneist.

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The authors declare that they have no conflict of interest.

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This research was performed in accordance with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individuals included in the study.

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Schiemer, J.F., Zimniak, L., Hadzijusufovic, E. et al. Novel multi-image view for neuromapping meets the needs of the robotic surgeon. Tech Coloproctol 22, 445–448 (2018).

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  • Robotic surgical procedures
  • Rectal cancer
  • Neuromonitoring
  • Autonomic pathways