For her work on intraoperative neuromonitoring of the pelvis, Ramona Schuler, a doctoral student at the Institute of Biomedical Engineering and Informatics (BMTI) at TU Ilmenau, is receiving the 2023 Patient Safety in Medical Technology Award. In her dissertation, supervised by Prof. Jens Haueisen, she developed a new measurement approach to identify autonomic nerves in the pelvic region and tested it for technical and clinical feasibility in two studies. In this way, she is helping to prevent consequential damage to patients as a result of operations on the rectum, prostate or uterus. The prize is endowed with 5,000 euros and is awarded by the German Society for Biomedical Engineering (VDE DGBMT) and the Patient Safety Action Alliance (APS).
Patient Safety Award: New measurement approach helps reduce risk of nerve injury during surgery
Operations in the pelvic region are demanding in any case, and there is also a very sensitive anatomy: the pelvic floor contains a fine, highly complex plexus of autonomic nerves that supply signals to the smooth muscles of the internal organs. If an operation is performed there, there is a very high risk of damaging this plexus. Consequential damage includes incontinence or sexual dysfunction. "Pelvic nerves are very difficult to identify visually, which is why a surgeon needs technical aids," explains Ramona Schuler.
My motivation was to find a solution that delivers valid results quickly and supports the surgeon as best as possible during an operation.
Identifying autonomic nerves via electrical tissue resistance of target organs.
The only commercially available method to date uses EMG (electromyographic testing), which is otherwise used to examine skeletal muscles, to measure the electrical activity of the muscles, which allows conclusions to be drawn about the associated nerves, based on action currents of the muscles, in combination with bladder pressure measurement. Before each stimulation, however, the bladder must be filled and then drained again, which takes some time. Ramona Schuler's new approach, on the other hand, works with bioimpedance measurement, which leads to valid results even when the bladder is empty. The electrical tissue resistance is measured here. "Since we are dealing with many impedance changes at the target organs that need to be interpreted, I have developed a software-based analysis tool," Schuler says. AMINA (Automatic Muscle Impedance and Nerve Analyzer) evaluates the acquired data and helps the surgeon quickly and easily identify functional autonomic nerves during surgery.
Ramona Schuler started her professional career after completing her medical technology studies in 2016 at neuromonitoring specialist Dr. Langer Medical in Waldkirch (Baden-Württemberg). After a few years in product management with a focus on research and development, she received an offer to do a PhD in 2019. "My master's thesis already focused on neuromonitoring of autonomic nerves, and the dissertation at TU Ilmenau on this topic was the logical continuation," Schuler says. "After the initial feasibility studies, we will now continue to work on the new measurement method as a team at Dr. Langer Medical so that the product can reach the market."
The German Society for Biomedical Engineering in the VDE (VDE DGBMT) is the scientific and technical society for medical technology in Germany. It networks experts from all areas of technology applications in medicine and deals with the entire range of topics in biomedical technology.
In the Aktionsbündnis Patientensicherheit e. V. (APS), representatives of the health care professions, their associations, patient organizations, and from industry and business have joined forces to build a common platform for improving patient safety in Germany. It is committed to safe healthcare and dedicated to researching, developing and disseminating methods suitable for this purpose.
More information about the new method of intraoperative neuromonitoring of the pelvis
Schuler, R., Goos, M., Langer, A. et al. A new method of intraoperative pelvic neuromonitoring: a preclinical feasibility study in a porcine model. Sci Rep 12, 3696 (2022): https://doi.org/10.1038/s41598-022-07576-8
Schuler, R., Marquardt, C., Kalev, G. et al. Technical aspects of a new approach to intraoperative pelvic neuromonitoring during robotic rectal surgery. Sci Rep 13, 17156 (2023). https://doi.org/10.1038/s41598-023-41859-y