CN109330591B - Evoked potential monitor for real-time monitoring cavernous nerve injury in laparoscopy - Google Patents
Evoked potential monitor for real-time monitoring cavernous nerve injury in laparoscopy Download PDFInfo
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- 210000003899 penis Anatomy 0.000 claims abstract description 28
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- 206010060862 Prostate cancer Diseases 0.000 abstract description 5
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- A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
- A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
- A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
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Abstract
The invention discloses an evoked potential monitor for monitoring cavernous nerve injury in real time in laparoscopy, which comprises a stimulation signal output line, a host, an evoked potential recording line and a reference electrode line. The stimulation signal output line comprises a nerve stimulation probe rod and an output line body which are sequentially connected, and the output line body is connected with the nerve stimulation probe rod and a current stimulation output socket of the evoked potential monitor through a connecting plug; the evoked potential recording wire comprises a positive needle recording electrode, a negative needle recording electrode and an evoked potential recording wire body which are respectively connected, and the evoked potential recording wire body is respectively connected to an evoked potential signal acquisition socket of the evoked potential monitor; the reference electrode wire comprises a needle-shaped reference electrode and a reference electrode wire body, and the reference electrode wire body is connected to a reference signal acquisition socket of the evoked potential monitor. The invention can realize real-time monitoring of cavernous nerve of penis in pelvic cavity operations such as celioscope radical prostate cancer operation or radical cystectomy.
Description
Technical Field
The invention belongs to the technical field of medical instruments, and particularly relates to an evoked potential instrument for monitoring cavernous nerve injury of a penis in real time in a laparoscopic surgery.
Background
Pelvic surgeries such as radical prostate cancer surgery, radical cystectomy and the like often damage Cavernous Nerve (CN) of the penis, and the incidence rate of post-operative penile Erectile Dysfunction (ED) can reach 25-90%, which seriously affects the life quality of patients. Although scholars such as Walsh, Donker, etc. have designed radical prostate cancer surgery with bilateral CN preservation and achieved some results, 14-69% of patients still develop ED to varying degrees after surgery. With the progressive aging of the incidence rate of prostate cancer and bladder cancer, patients have higher requirements on post-operative erectile function, and CN is usually required to be reserved in the operation.
The reasons for the difficulty in retaining CN in the operation are mainly: the variability of CN anatomical positions shows that only 52% of men have normal and clear CN running; CN is covered with connective tissue, and the separation is difficult; ③ bleeding causes the blurring of the operative field; poor CN exposure due to posture. There are two main methods for positioning CN in the current surgery:
(1) suspicious nerves were electrically stimulated and CN was located by monitoring changes in the circumference of the root of the penis.
The CaverMap is currently the only FDA approved instrument for intraoperative CN monitoring. In pelvic surgery, CN is positioned by electrically stimulating suspicious nerves and measuring the change of the circumference of the root of the penis. Early studies demonstrated that the CaverMap can effectively help identify CN and identify the integrity of CN pathways post-operatively. Klotz et al, using comparative studies, found that patients who were not monitored using the CaverMap apparatus in CN-retaining radical prostate cancer surgery recovered erectile function (partial and full) only 30% after surgery, while patients monitored using the CaverMap apparatus recovered erectile function approximately 94% after surgery.
However, as the research progresses, more and more results show that the CaverMap has poor repeatability and low sensitivity and specificity, and the postoperative response of the CaverMap cannot reflect the postoperative erectile function of the patient, and the reasons may be related to the following reasons: the delayed reaction may be caused in the operation, for example, the current reaction state is the reaction of the previous stimulation; in the operation, the tiny operation in the CN running area can cause the change of the penis circumference, and the wrong judgment is generated on the reaction generated by the stimulation; spontaneous change of the penis circumference in the operation can mislead the operator; the influence of the anesthesia mode and the anesthesia depth in the operation on the circumference of the penis.
(2) Suspicious nerves were electrically stimulated and CN was located by monitoring changes in intracavernous pressure (ICP).
In view of the deficiencies of the CaverMap instrument, the Kurokawa team stimulated the suspect nerve through bipolar electrodes, monitoring changes in ICP located CN intra-operatively. Studies have shown that the ICP technique reacts faster than the CaverMap, results are stable, and has higher specificity and sensitivity, but measuring ICP once requires about 10-60s, and 1-2 min between each stimulation is required to wait for the ICP to stabilize, resulting in prolonged surgical time. And as well as CaverMap, does not allow for continuous intra-operative monitoring, while intermittent nerve monitoring may still result in nerve damage.
Accordingly, under the guidance of the accurate medical strategy, researchers at home and abroad make extensive attempts and a lot of researches, such as positioning and monitoring CN by using the technologies of laser nerve stimulation, dye fluorescence imaging, photoacoustic imaging, intraoperative nuclear magnetic resonance and the like, but the effect is not good enough.
Evoked Potentials (EPs) refer to appropriate stimulation given to a specific part of the nervous system (including from a receptor to a cerebral cortex), or processing stimulation information by the brain, detecting bioelectric responses having a fixed time interval and a specific phase with the stimulation at the corresponding part of the nervous system, having a strict time-locking effect, and being the next development of neuroelectrophysiology following electrocardio, electroencephalogram and myoelectricity. EPs are currently used in spinal surgery for monitoring spinal cord injuries. Clinical research shows that somatosensory evoked potentials (MEPs) can realize real-time monitoring of spinal cord injury in spinal surgery, and the sensitivity and specificity of the MEPs are as high as 94.4% and 100%.
The information disclosed in this background section is only for enhancement of understanding of the general background of the invention and should not be taken as an acknowledgement or any form of suggestion that this information forms the prior art already known to a person skilled in the art.
Disclosure of Invention
The invention aims to provide an evoked potential monitor for monitoring cavernous nerve injury of a penis in real time in laparoscopy.
In order to solve the above problems, the patent proposes the following technical solutions: a real-time monitoring evoked potential apparatus for cavernous body nerves of penis in laparoscopy comprises a stimulation signal output line, wherein the stimulation signal output line comprises a nerve stimulation probe rod and an output line body which are sequentially connected; the output line body is connected with the nerve stimulation probe rod and a current stimulation output socket of the evoked potential monitor through a connecting plug; the evoked potential recording line comprises a positive needle recording electrode, a negative needle recording electrode and a corresponding evoked potential recording line body which are respectively connected; the evoked potential recording line body is respectively connected to an evoked potential signal acquisition input socket of an evoked potential monitor; the reference electrode wire comprises a needle-shaped reference electrode and a reference electrode wire body, and the reference electrode wire body is connected to a reference signal acquisition socket of the evoked potential monitor.
Preferably, the nerve stimulation probe rod is 5mm in diameter and 340mm in length, the hook-shaped electrode is arranged at the front end and about 2cm in length, the outer layer of the other part is an insulator, and the tail end of the nerve stimulation probe rod is connected with the output line body.
Preferably, the nerve stimulation probe rod can stimulate the position of a suspicious cavernous body nerve of a penis in the operation through a puncture curved card in the laparoscope operation through a stimulation electrode at the front end of the nerve stimulation probe rod, is suitable for the laparoscopic minimally invasive operation, and can avoid the damage to other tissues through an insulating layer at the periphery of the nerve stimulation probe rod.
Preferably, the positive electrode, the negative electrode and the reference electrode needle are needle-shaped electrodes and are cylindrical.
Preferably, the potential monitor includes: the stimulation signal output line comprises a nerve stimulation probe rod and an output line body which are connected in sequence; the output line plug is connected to a current stimulation output socket of the evoked potential monitoring instrument; the evoked potential positive recording line comprises a positive needle-shaped recording body and an evoked potential positive recording line body which are sequentially connected, and is connected to a signal acquisition input socket of the evoked potential monitor through an input line plug; the evoked potential negative pole recording line comprises a negative pole needle-shaped recording body and an evoked potential negative pole recording line body which are sequentially connected, and is connected to a signal acquisition input socket of the evoked potential monitor through an input line plug; the reference electrode wire comprises a reference electrode wire reference electrode and a reference electrode wire body which are connected in sequence, and the reference electrode wire reference electrode and the reference electrode wire body are connected to a reference signal input socket of the evoked potential monitor through a reference electrode wire connecting plug.
Compared with the prior art, the invention can realize the following beneficial effects: compared with the prior art that the change of the circumference of the root of the penis or the pressure of the cavernous body of the penis is monitored, and the damage of the cavernous body nerve of the penis is monitored by adopting the change of evoked potential, the instantaneity and the effectiveness of monitoring can be realized, the requirement of the patent on an operator is not high, and the suspicious nerve part in the operation can be monitored in real time;
the invention realizes real-time monitoring of the cavernous body nerve of the penis by inserting the positive electrode and the negative electrode into the root part and the coronary sulcus of the cavernous body of the penis and utilizing the domination relationship between the cavernous body nerve of the penis and the cavernous body of the penis, thereby avoiding damaging the cavernous body nerve of the penis when dissecting prostate during operation and furthest reserving the post-operation erection function of a patient.
Drawings
FIG. 1 is a schematic diagram of a stimulation probe of an evoked potential apparatus for real-time monitoring of cavernous nerve injury of penis in laparoscopy according to the present invention;
FIG. 2 is a schematic diagram showing the structure of the stimulation output signal of the evoked potential equipment for real-time monitoring of the cavernous nerve injury of the penis in laparoscopy according to the present invention;
FIG. 3 is a schematic diagram of the structure of evoked potential recording lines and reference electrode lines of the evoked potential apparatus for real-time monitoring of cavernous nerve injury of penis in laparoscopy of the present invention;
FIG. 4 is a schematic diagram of the evoked potential monitoring apparatus in practical use in laparoscopy;
wherein, 1, a nerve stimulation probe rod; 2. a stimulus signal output line; 3. an evoked potential recording line and a reference electrode line; 4. the actual use schematic diagram of the evoked potential monitor; 101. a hook-shaped electrode of the nerve stimulation probe rod; 102. a neurostimulation probe body; 103. a peripheral insulating layer of the nerve stimulation probe rod; 104. the stimulation probe rod is connected with the output line body through the socket; 205. an output line body; 206. the output line body is connected with the stimulating probe rod through a plug; 207. the output line body is connected with the evoked potential monitor plug; 3A08, evoked potential positive electrode recording line needle electrode; 3A09, evoked potential positive pole recording line body; 3A10, an evoked potential positive recording wire and an evoked potential monitor connecting plug; 3B11, evoked potential negative recording line needle electrode; 3B12, evoked potential negative pole record line body; 3B13, an evoked potential negative electrode recording wire and an evoked potential monitor connecting plug; 3C14, reference electrode line reference electrode; 3C15, reference electrode line body; 3C16, a reference electrode wire and an evoked potential monitor connecting plug; 417. the evoked potential monitor is connected with the stimulation signal output line through a socket; 418. the evoked potential monitor is connected with the socket of the evoked potential positive recording line; 419. the evoked potential monitor is connected with the evoked potential negative pole recording line through a socket; 420. the evoked potential monitor is connected with the reference electrode wire connecting socket; 421. puncture curved card in peritoneoscope art.
Detailed Description
The evoked potential equipment for real-time monitoring of cavernous nerve injury of penis in laparoscopy of the invention is further described in detail with reference to the accompanying drawings.
As shown in fig. 1 to 4, the evoked potential apparatus for real-time monitoring of cavernous nerve injury of penis in laparoscopy of the present invention comprises: the stimulation signal output line 2 comprises a nerve stimulation probe rod 1 and an output line body 205 which are sequentially connected; the output line body and evoked potential monitor connecting plug 207 is connected to an evoked potential monitor and stimulus signal output line connecting socket 417; the evoked potential positive recording line 3A comprises an evoked potential positive recording line needle electrode 3A08 and an evoked potential positive recording line body 3A09 which are connected in sequence, and is connected to the evoked potential monitor and stimulation signal output line connecting socket 418 through an evoked potential positive recording line and evoked potential monitor connecting plug 3A 10; the evoked potential negative recording wire 3B comprises an evoked potential negative recording wire needle-shaped electrode 3B11 and an evoked potential negative recording wire body 3B12 which are connected in sequence, and is connected to an evoked potential monitor and evoked potential negative recording wire connecting socket 419 through an evoked potential negative recording wire and evoked potential monitor connecting plug 3B 13; the reference electrode wire 3C comprises a reference electrode wire reference electrode 3C14 and a reference electrode wire body 3C15 which are connected in sequence, and is connected to the evoked potential monitor and reference electrode wire connecting socket 420 through a reference electrode wire and evoked potential monitor connecting plug 3C 16.
When the device is used, the stimulation signal output line 2 is connected to an evoked potential monitoring instrument through the output line body and the stimulation probe rod connecting plug 207, and carries out electrical stimulation on a suspected nerve part in a laparoscope through the nerve stimulation probe rod hook-shaped electrode 101;
the evoked potential positive recording wire 3A and the evoked potential monitor connecting plug 3A10 are connected to the evoked potential monitor and the evoked potential positive recording wire connecting socket 418, the evoked potential negative recording wire 3B and the evoked potential monitor connecting plug 3B13 are connected to the evoked potential monitor and the evoked potential negative recording wire connecting socket 419, the evoked potential positive recording wire needle-shaped electrode 3A08 is inserted into the root of the penis, the evoked potential negative recording wire needle-shaped electrode 3B11 is inserted into the coronary sulcus of the penis, the reference electrode wire reference electrode 3C14 is inserted into the root of the thigh of the patient, and the reference electrode wire and the evoked potential monitor connecting plug 3C16 is inserted into the evoked potential monitor and reference electrode wire connecting socket 420 for recording the evoked potential of the patient.
Meanwhile, the evoked potential positive recording line body 3A09 is made red, the evoked potential negative recording line body 3B12 is made yellow, and the reference electrode line body 3C15 is made black, so that the distinctive distinction is formed, and the distinction is more obvious and easy to distinguish.
In addition, the nerve stimulation probe rod 1 is set to be 5mm in diameter and 340mm in length, the front end of the nerve stimulation probe rod is a hook-shaped electrode, the periphery of the rest part of the nerve stimulation probe rod is wrapped by insulating materials, operation in the operation can be carried out through the puncture curved card 418 in the laparoscopy, other tissues are effectively prevented from being damaged in the operation, the length of the evoked potential recording wire and the length of the reference electrode wire 3 are 1.5 m, and the nerve stimulation probe rod is suitable for being used in the operation.
While the preferred embodiments of the present invention have been described in detail, it is not intended that the invention be limited thereto, and that various equivalent modifications or substitutions can be made by those skilled in the art without departing from the spirit of the present invention and are intended to be included within the scope of the present application.
Claims (4)
1. An evoked potential monitor for real-time monitoring cavernous nerve injury in laparoscopy, comprising:
the stimulation signal output line comprises a nerve stimulation probe rod and an output line body which are sequentially connected; the output line body is connected with the nerve stimulation probe rod and a current stimulation output socket of the evoked potential monitor through a connecting plug; the front end of the nerve stimulation probe rod is provided with a hook-shaped stimulation electrode, the tail end of the nerve stimulation probe rod is connected with an output line body and is connected with an evoked potential monitor, and the hook-shaped stimulation electrode electrically stimulates a suspicious nerve part in the laparoscopy;
the evoked potential recording line comprises a positive needle recording electrode, a negative needle recording electrode and a corresponding evoked potential recording line body which are respectively connected; the evoked potential recording line body is respectively connected to a signal acquisition input socket of the evoked potential monitor; the recording electrode is a needle-shaped recording electrode, is divided into a positive electrode and a negative electrode, and is respectively inserted into the root of the penis and the coronary sulcus of the penis;
the reference electrode wire comprises a needle-shaped reference electrode and a reference electrode wire body, and the reference electrode wire body is connected to a reference signal acquisition socket of the evoked potential monitor;
the reference electrode is a needle electrode inserted into the root of the thigh of the patient.
2. The evoked potential monitor for real-time monitoring cavernous nerve injury in laparoscopy according to claim 1, wherein the surgical stimulation electrode is a probe rod, the front end of the surgical stimulation electrode is a hook-shaped electrode with a stimulation electrode length of about 2cm, the other part of the surgical stimulation electrode except the stimulation electrode at the front end is wrapped by an insulating material, the tail end of the surgical stimulation electrode is connected with an output line body, and the stimulation electrode can be applied to laparoscopic surgery through a laparoscopic puncture curved card and can avoid damage to peripheral tissues.
3. The evoked potential monitor for real-time monitoring of cavernous nerve injury during laparoscopy according to claim 1, wherein the recording electrode and the reference electrode are needle electrodes.
4. The apparatus of claim 1, wherein the apparatus comprises: the stimulation signal output line comprises a nerve stimulation probe rod and an output line body which are sequentially connected; the output line plug is connected to a current stimulation output socket of the evoked potential monitoring instrument; the evoked potential positive recording line comprises a positive needle-shaped recording body and an evoked potential positive recording line body which are sequentially connected, and is connected to a signal acquisition input socket of the evoked potential monitor through an input line plug; the evoked potential negative pole recording line comprises a negative pole needle-shaped recording body and an evoked potential negative pole recording line body which are sequentially connected, and is connected to a signal acquisition input socket of the evoked potential monitor through an input line plug; the reference electrode wire comprises a reference electrode wire reference electrode and a reference electrode wire body which are connected in sequence, and the reference electrode wire reference electrode and the reference electrode wire body are connected to a reference signal input socket of the evoked potential monitor through a reference electrode wire connecting plug.
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| CN109758226B (en) * | 2019-03-21 | 2024-05-31 | 武汉金柏威光电技术有限公司 | Neural monitoring bipolar minimally invasive instrument |
| CN111839512A (en) * | 2019-04-29 | 2020-10-30 | 上海市第五人民医院 | Nerve monitoring and protecting combined device in pelvic autonomic nerve operation |
| CN113576418B (en) * | 2021-08-19 | 2024-05-14 | 西安交通大学第二附属医院 | Dorsum penis nerve detection method based on somatosensory evoked potential signals |
| CN114621922A (en) * | 2022-02-15 | 2022-06-14 | 中山大学附属第五医院 | Extraction, purification and culture method of rat cavernous nerve derived Schwann cells |
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| US5284153A (en) * | 1992-04-14 | 1994-02-08 | Brigham And Women's Hospital | Method for locating a nerve and for protecting nerves from injury during surgery |
| US7628761B2 (en) * | 1997-07-01 | 2009-12-08 | Neurometrix, Inc. | Apparatus and method for performing nerve conduction studies with localization of evoked responses |
| US6259945B1 (en) * | 1999-04-30 | 2001-07-10 | Uromed Corporation | Method and device for locating a nerve |
| EP1372780A4 (en) * | 2001-03-30 | 2006-06-14 | Univ Case Western Reserve | Systems and methods for selectively stimulating components in, on, or near the pudendal nerve or its branches to achieve selective physiologic responses |
| US7865250B2 (en) * | 2004-06-10 | 2011-01-04 | Medtronic Urinary Solutions, Inc. | Methods for electrical stimulation of nerves in adipose tissue regions |
| CN101332090A (en) * | 2007-06-26 | 2008-12-31 | 北京松上技术有限公司 | Peris erection detection sensing device and detection device |
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| US9999463B2 (en) * | 2014-04-14 | 2018-06-19 | NeuroMedic, Inc. | Monitoring nerve activity |
| CN104688186A (en) * | 2015-02-12 | 2015-06-10 | 赵军 | Detection device for conduction velocity of dorsal penile nerve branches |
| US10232175B2 (en) * | 2016-06-22 | 2019-03-19 | Marc Possover | Retropubic implantation of a microstimulator for genital nerves stimulation |
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