ProPep -Nerve Monitoring System
The ProPep® Nerve Monitoring System provides surgeons information useful in identifying the location of, and monitoring the integrity of nerves critical to sexual function and urinary continence during laparoscopic, da Vinci® and other robotic prostatectomy surgeries. For decades, physicians performing spine, maxillofacial and various orthopedic surgeries have relied on intraoperative nerve monitoring to provide real-time, accurate information on the location and function of nerves to help prevent neural damage that can occur as a result of surgical manipulation. The ProPep® Nerve Monitoring System allows this proven nerve monitoring technology to be used, for the first time ever, during laparoscopic and robotic prostatectomy surgery.
Surgeons using the ProPep® Nerve Monitoring System have additional information during the operation that can potentially help him or her reduce inadvertent damage to critical nerves. By enabling the surgeon to identify and monitor the function of otherwise invisible pelvic nerves during surgery, the ProPep® Nerve Monitoring System helps the surgeon make a more informed decision about critical tissue manipulation during the procedure.? The product allows him or her to:
- Identify the location and assess the integrity of nerves critical to sexual function and urinary control prior to prostate removal
- Verify the location of these nerves throughout the surgery
- Validate the integrity of the nerves after prostate removal
For the patient, this means potentially reducing the sexual dysfunction and urinary incontinence that are common side effects of these surgical procedures.
Sexual dysfunction and urinary incontinence are both common side effects following prostate cancer surgery and inadvertent nerve injury occurring during the surgery is believed to be one of the primary causes.[1, 2] To avoid nerve damage during surgery, surgeons typically employ a nerve-sparing procedure and although these nerves-sparing procedures have significantly reduced the incidence of sexual dysfunction and incontinence following prostatectomy surgery, literature still reports
38% - 40% of patients experience sexual dysfunction [8]
20% - 44% of patients are incontinent 12 months after “successful” nerve-sparing, robotic-assisted prostatectomy surgery [3]
There are two types of nerves responsible for controlling sexual function and urinary continence – autonomic nerves and somatic nerves.[4] Both types of nerves are too small to be seen, as a result, surgeons must rely on anatomic landmarks to determine what tissue to avoid to keep from damaging them during the surgery. The nerve-sparing procedures the surgeons currently perform rely on these landmarks. Unfortunately, published literature has shown the location of the somatic nerves involved in sexual function and continence control vary considerably and these anatomic landmarks are not always reliable in identifying where they are. [5, 6, 7]
The solution to identifying these critical somatic nerves - the ProPep® Nerve Monitoring System.
The ProPep® Nerve Monitoring System consists of:
- Pep Monitor® - generates the specific electrical signal used to stimulate the tissue of interest, and records, analyzes and displays the response to that signal.
- Pep Control Switch® - enables the surgeon to switch the robotic surgical instrument from cautery mode to stimulation mode and back. (The electrical stimulation signal generated by the Pep Monitor is delivered through the surgeon’s robotic surgical instrument thus eliminating the need to introduce a separate stimulation probe into the surgical field.)
- Pep Electrode® Kit - a single use disposable, containing the Pep Electrode® and the Pep Electrode® Introducer. The Pep Electrode® is connected to the Pep Monitor® and introduced into the surgical field via the Pep Electrode® Introducer. Once in the surgical field, the Pep Electrode® is placed in the tissue of interest to receive the electrical signals generated as a result of tissue stimulation.