Gynecologic CancerNCT07925463
Comparison of NMTCuff and Standard TOF in Gynecologic Oncology Surgery (NMTCUFF-TOF)
An observational study of Gynecologic Cancer and Neuromuscular Blockade, run by Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital at 1 site in Turkey (Türkiye).
Trial summary
The use of neuromuscular blocking (NMB) agents in modern anesthesia is essential for optimizing surgical exposure and ensuring patient safety. Inadequate neuromuscular recovery at the end of surgery, known as residual curarization, poses significant risks for critical postoperative respiratory complications… Read more about this study
- Who is it for?
- Ages 18 to 75 years, women only
- Conditions the study is for
- Gynecologic Cancer, Neuromuscular Blockade, Residual Neuromuscular Block
- What is being tested?
- Dual Neuromuscular Transmission Monitoring
- How many people
- 45 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 1 Sep 2026to 30 Nov 2026
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 75 years
- Women only
- No healthy volunteers
- Adult, Older adult
Study population: Patients aged 18-75 years with an ASA status of I-III who are scheduled to undergo elective laparoscopic gynecologic oncology surgery at Dr. Abdurrahman Yurtarslan Oncology Training and Research Hospital.
Who may be able to join
- Patients scheduled for elective laparoscopic gynecologic oncology surgery
- Aged between 18 and 75 years
- American Society of Anesthesiologists (ASA) physical status I-III
- Patients who provide written and verbal informed consent
Who cannot join
- Known history of neuromuscular disease
- Severe hepatic or renal insufficiency
- Body Mass Index (BMI) greater than 35 kg/m2
- Patient refusal to participate
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Turkey (Türkiye)1 site, 1 recruiting
- Recruiting
Dr. Abdurrahman Yurtarslan Oncology Training and Research Hospital
Ankara
Ozge Cihangir Ozek, MD, 05064969856, ozgecihangirozek@hotmail.com
About this study
Official title: Comparison of Neuromuscular Blockade Monitoring Methods in Gynecologic Oncology Surgery: NMTCuff (Vision Duo) Versus Standard Train-of-Four (Acceleromyography)
The use of neuromuscular blocking (NMB) agents in modern anesthesia is essential for optimizing surgical exposure and ensuring patient safety. Inadequate neuromuscular recovery at the end of surgery, known as residual curarization, poses significant risks for critical postoperative respiratory complications, aspiration pneumonia, and prolonged recovery times. Therefore, objective neuromuscular monitoring is strongly recommended by international guidelines, including the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology and Intensive Care (ESAIC).
In gynecologic oncology surgery, laparoscopic and robotic approaches often require deep neuromuscular blockade (Post-Tetany Count 1-2) to improve abdominal exposure and allow surgeons to work at lower intraperitoneal pressures. However, the extreme Trendelenburg position and the "tucked-in" positioning of the arms under surgical drapes limit the feasibility of traditional acceleromyography (AMG) monitoring methods. Since AMG devices require free movement of the thumb (m. adductor pollicis), they can yield false-positive or unreliable results when the arms are inaccessible, forcing clinicians to rely on subjective monitoring.
Read more
The NMTCuff technology, used by the Vision Duo monitor, measures the neuromuscular response via the contraction pressure of the upper arm muscles (m. triceps/biceps brachii) rather than the wrist. Literature indicates that the response of upper arm muscles correlates better with the diaphragm and laryngeal muscles regarding NMB sensitivity compared to the wrist. This feature suggests that the Vision Duo might detect the recovery of respiratory functions earlier and more reliably.
This study aims to evaluate the correlation and time differences in Train-of-Four (TOF) ratios between the NMTCuff and standard AMG methods during gynecologic oncology surgery. Additionally, it will assess the ease of setup and signal continuity of both devices when the patient's arms remain covered under surgical drapes.
This study is purely prospective and observational in terms of clinical management. The neuromuscular monitoring methods used will not interfere with routine anesthesia care, drug dosing, muscle relaxant reversal strategies, or extubation decisions. The clinician performing the anesthesia management will follow the institutional routine protocol, and data from both devices will only be recorded simultaneously and matched for statistical comparison.
Read the detailed description
Following approval from the institutional non-interventional clinical research ethics committee and obtaining written and verbal informed consent from all participating patients, this prospective study will be conducted on patients scheduled for elective laparoscopic gynecologic oncology surgery. Patients aged 18-75 years with an American Society of Anesthesiologists (ASA) physical status of I-III will be included. Exclusion criteria consist of a known history of neuromuscular disease, severe hepatic or renal insufficiency, a Body Mass Index (BMI) greater than 35 kg/m2, and patient refusal to participate.
Upon arrival in the operating room, standard monitoring will be applied to all patients, including electrocardiography (ECG), peripheral oxygen saturation (SpO2), and non-invasive blood pressure (NIBP). Anesthesia induction will follow a standardized routine institutional protocol: propofol 2-3 mg/kg, remifentanil 0.5-1 mcg/kg, and rocuronium 0.6 mg/kg to facilitate endotracheal intubation and induce neuromuscular blockade.
Simultaneously, two different neuromuscular monitoring methods will be applied to each patient as follows:
Group 1 - NMTCuff (Vision Duo): Measurements will be performed using a specialized NMT cuff belonging to the Vision Duo monitor. This cuff is placed around the patient's non-dominant upper arm, and neuromuscular transmission is assessed via pressure-sensitive sensors during muscle contraction.
Group 2 - AMG (Standard TOF): Measurements will be performed using a standard acceleromyography (AMG) Train-of-Four (TOF) sensor attached to the contralateral wrist along the ulnar nerve pathway.
At the end of the surgical procedure, routine reversal of the neuromuscular blockade will be performed using Sugammadex at a dose of 2 mg/kg. The recovery times-specifically the duration from the exact moment of Sugammadex administration until the TOF ratio reaches 90% and 100% (matching the Vision Duo Auto-Pilot specification)-will be recorded separately for both devices using a digital stopwatch. Clinical assessment parameters at the time of extubation, including tidal volume and the 5-second head lift test, will also be documented.
This study is purely prospective and observational regarding clinical anesthesia management. The alternative monitoring methods will not intervene in or alter the routine anesthesia care, muscle relaxant dosages, reversal strategies, or extubation decisions. The attending clinician will manage the patient according to the standard operating room practices, and data from both devices will only be recorded simultaneously and matched for subsequent statistical analysis.
- Being tested
- Dual Neuromuscular Transmission Monitoring
- Keywords
- NMTCuff, Acceleromyography, Train-of-Four Monitoring, Gynecologic Oncology Surgery, Sugammadex
- Medical subject headings
- Delayed Emergence from Anesthesia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Dual Neuromuscular Transmission MonitoringOther
Simultaneous recording and matching of data from two different neuromuscular monitoring devices: NMTCuff (Vision Duo) utilizing pressure-sensitive sensors on the non-dominant upper arm, and standard Acceleromyography (AMG) on the contralateral wrist. This monitoring is part of the standard routine anesthesia care and does not interfere with clinical decisions.
| Study group | Role | What they receive |
|---|---|---|
| Simultaneous Dual NMT Cohort | A single cohort of patients where each patient receives two different neuromuscular transmission (NMT) monitoring methods simultaneously on opposite arms during elective laparoscopic gynecologic oncology surgery. Receives: Other: Dual Neuromuscular Transmission Monitoring |
What is being measured
The primary outcome is the main question the study is designed to answer.
Time to Neuromuscular Recovery (TOF Ratio >= 0.90)
The time interval (measured in minutes) from the exact moment of the neuromuscular blockade reversal agent (Sugammadex 2 mg/kg) administration until the Train-of-Four (TOF) ratio reaches 90%. This recovery time will be tracked and recorded simultaneously for both the NMTCuff (Vision Duo) and the standard acceleromyography (AMG) devices using a digital stopwatch to evaluate the limits and correlation between the two monitoring methods.
Measured: From the exact moment of Sugammadex administration up to endotracheal extubation (approximately 10 to 20 minutes).
Secondary outcomes (1)
Technical Feasibility and Signal Continuity Under Surgical Drapes
Evaluation of device installation ease, maintenance of stable sensor connections, and the frequency/duration of any signal loss during the operation. This measure assesses the clinical utility of both devices specifically when the patient's arms are tucked-in along their sides and completely covered under surgical drapes in the extreme Trendelenburg position.
Measured: From the initiation of anesthesia monitoring in the operating room until the end of the surgical procedure (up to 4 hours).
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted9 Nov 2026
- Study start1 Sep 2026
- Primary completion1 Nov 2026
- Study completion30 Nov 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Gynecologic CancerStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 45 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, özge cihangir özek, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital
- Investigators
- Özge Cihangir Özek, MD, Principal investigator, Abdurrahman YAOTRH
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07925463
- Sponsor's protocol ID
- 2026-06/129
- Status last verified
- Nov 2026
- First submitted
- 3 Nov 2026
- Last updated
- 9 Nov 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Radkowski P, Baranska A, Mieszkowski M, Dawidowska-Fidrych J, Podhorodecka K. Methods for Clinical Monitoring of Neuromuscular Transmission in Anesthesiology - A Review. Int J Gen Med. 2024 Jan 3;17:9-20. doi: 10.2147/IJGM.S424555. eCollection 2024.
PubMed 38196564Rodney G, Raju P, Brull SJ. Neuromuscular block management: evidence-based principles and practice. BJA Educ. 2024 Jan;24(1):13-22. doi: 10.1016/j.bjae.2023.10.005. Epub 2023 Nov 29. No abstract available.
PubMed 38495745Radkowski P, Rusc J, Keska M. Comparison of measurements obtained with TOF-Cuff placed on the arm and the TOF-Scan on the adductor pollicis muscle during general anaesthesia using mivacurium: a prospective observational clinical trial. Sci Rep. 2024 Nov 8;14(1):27180. doi: 10.1038/s41598-024-76086-6.
PubMed 39516501
Study at a glance
From the registry record, last updated by the sponsor on 9 Nov 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparison of Neuromuscular Blockade Monitoring Methods in Gynecologic Oncology Surgery: NMTCuff (Vision Duo) Versus Standard Train-of-Four (Acceleromyography)
- ClinicalTrials.gov ID
- NCT07925463
- Acronym / sponsor ID
- 2026-06/129
- Keywords
- NMTCuff, Acceleromyography, Train-of-Four Monitoring, Gynecologic Oncology Surgery, Sugammadex
- Study type
- Observational
- Recruitment status
- Recruiting
- Enrolment
- 45 participants (estimated)
- Lead sponsor
- Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research HospitalUniversity, hospital or other
- Study start
- 1 Sep 2026 (actual)
- Primary completion
- 1 Nov 2026 (actual)
- Study completion
- 30 Nov 2026 (estimated)
- First posted
- 9 Nov 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The use of neuromuscular blocking (NMB) agents in modern anesthesia is essential for optimizing surgical exposure and ensuring patient safety. Inadequate neuromuscular recovery at the end of surgery, known as residual curarization, poses significant risks for critical postoperative respiratory complications, aspiration pneumonia, and prolonged recovery times. Therefore, objective neuromuscular monitoring is strongly recommended by international guidelines, including the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology and Intensive Care (ESAIC).
In gynecologic oncology surgery, laparoscopic and robotic approaches often require deep neuromuscular blockade (Post-Tetany Count 1-2) to improve abdominal exposure and allow surgeons to work at lower intraperitoneal pressures. However, the extreme Trendelenburg position and the "tucked-in" positioning of the arms under surgical drapes limit the feasibility of traditional acceleromyography (AMG) monitoring methods. Since AMG devices require free movement of the thumb (m. adductor pollicis), they can yield false-positive or unreliable results when the arms are inaccessible, forcing clinicians to rely on subjective monitoring.
The NMTCuff technology, used by the Vision Duo monitor, measures the neuromuscular response via the contraction pressure of the upper arm muscles (m. triceps/biceps brachii) rather than the wrist. Literature indicates that the response of upper arm muscles correlates better with the diaphragm and laryngeal muscles regarding NMB sensitivity compared to the wrist. This feature suggests that the Vision Duo might detect the recovery of respiratory functions earlier and more reliably.
This study aims to evaluate the correlation and time differences in Train-of-Four (TOF) ratios between the NMTCuff and standard AMG methods during gynecologic oncology surgery. Additionally, it will assess the ease of setup and signal continuity of both devices when the patient's arms remain covered under surgical drapes.
This study is purely prospective and observational in terms of clinical management. The neuromuscular monitoring methods used will not interfere with routine anesthesia care, drug dosing, muscle relaxant reversal strategies, or extubation decisions. The clinician performing the anesthesia management will follow the institutional routine protocol, and data from both devices will only be recorded simultaneously and matched for statistical comparison.
Detailed description
Following approval from the institutional non-interventional clinical research ethics committee and obtaining written and verbal informed consent from all participating patients, this prospective study will be conducted on patients scheduled for elective laparoscopic gynecologic oncology surgery. Patients aged 18-75 years with an American Society of Anesthesiologists (ASA) physical status of I-III will be included. Exclusion criteria consist of a known history of neuromuscular disease, severe hepatic or renal insufficiency, a Body Mass Index (BMI) greater than 35 kg/m2, and patient refusal to participate.
Upon arrival in the operating room, standard monitoring will be applied to all patients, including electrocardiography (ECG), peripheral oxygen saturation (SpO2), and non-invasive blood pressure (NIBP). Anesthesia induction will follow a standardized routine institutional protocol: propofol 2-3 mg/kg, remifentanil 0.5-1 mcg/kg, and rocuronium 0.6 mg/kg to facilitate endotracheal intubation and induce neuromuscular blockade.
Simultaneously, two different neuromuscular monitoring methods will be applied to each patient as follows:
Group 1 - NMTCuff (Vision Duo): Measurements will be performed using a specialized NMT cuff belonging to the Vision Duo monitor. This cuff is placed around the patient's non-dominant upper arm, and neuromuscular transmission is assessed via pressure-sensitive sensors during muscle contraction.
Group 2 - AMG (Standard TOF): Measurements will be performed using a standard acceleromyography (AMG) Train-of-Four (TOF) sensor attached to the contralateral wrist along the ulnar nerve pathway.
At the end of the surgical procedure, routine reversal of the neuromuscular blockade will be performed using Sugammadex at a dose of 2 mg/kg. The recovery times-specifically the duration from the exact moment of Sugammadex administration until the TOF ratio reaches 90% and 100% (matching the Vision Duo Auto-Pilot specification)-will be recorded separately for both devices using a digital stopwatch. Clinical assessment parameters at the time of extubation, including tidal volume and the 5-second head lift test, will also be documented.
This study is purely prospective and observational regarding clinical anesthesia management. The alternative monitoring methods will not intervene in or alter the routine anesthesia care, muscle relaxant dosages, reversal strategies, or extubation decisions. The attending clinician will manage the patient according to the standard operating room practices, and data from both devices will only be recorded simultaneously and matched for subsequent statistical analysis.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Simultaneous Dual NMT Cohort | – | Other: Dual Neuromuscular Transmission MonitoringA single cohort of patients where each patient receives two different neuromuscular transmission (NMT) monitoring methods simultaneously on opposite arms during elective laparoscopic gynecologic oncology surgery. |
Who may qualify
- Ages
- 18 to 75 years
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Patients aged 18-75 years with an ASA status of I-III who are scheduled to undergo elective laparoscopic gynecologic oncology surgery at Dr. Abdurrahman Yurtarslan Oncology Training and Research Hospital.
Key inclusion criteria (4 listed)
- Patients scheduled for elective laparoscopic gynecologic oncology surgery
- Aged between 18 and 75 years
- American Society of Anesthesiologists (ASA) physical status I-III
- Patients who provide written and verbal informed consent
Key exclusion criteria (4 listed)
- Known history of neuromuscular disease
- Severe hepatic or renal insufficiency
- Body Mass Index (BMI) greater than 35 kg/m2
- Patient refusal to participate
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Dual Neuromuscular Transmission MonitoringSimultaneous recording and matching of data from two different neuromuscular monitoring devices: NMTCuff (Vision Duo) utilizing pressure-sensitive sensors on the non-dominant upper arm, and standard Acceleromyography (AMG) on the contralateral wrist. This monitoring is part of the standard routine anesthesia care and does not interfere with clinical decisions. | Other | Simultaneous Dual NMT Cohort |
Primary outcome
Time to Neuromuscular Recovery (TOF Ratio >= 0.90)
Time frame: From the exact moment of Sugammadex administration up to endotracheal extubation (approximately 10 to 20 minutes).
The time interval (measured in minutes) from the exact moment of the neuromuscular blockade reversal agent (Sugammadex 2 mg/kg) administration until the Train-of-Four (TOF) ratio reaches 90%. This recovery time will be tracked and recorded simultaneously for both the NMTCuff (Vision Duo) and the standard acceleromyography (AMG) devices using a digital stopwatch to evaluate the limits and correlation between the two monitoring methods.
1 secondary outcome
Technical Feasibility and Signal Continuity Under Surgical Drapes
Time frame: From the initiation of anesthesia monitoring in the operating room until the end of the surgical procedure (up to 4 hours).
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 9 Nov 2026.
- Background: PubMed 38196564Radkowski P, Baranska A, Mieszkowski M, Dawidowska-Fidrych J, Podhorodecka K. Methods for Clinical Monitoring of Neuromuscular Transmission in Anesthesiology - A Review. Int J Gen Med. 2024 Jan 3;17:9-20. doi: 10.2147/IJGM.S424555. eCollection 2024.
- Background: PubMed 38495745Rodney G, Raju P, Brull SJ. Neuromuscular block management: evidence-based principles and practice. BJA Educ. 2024 Jan;24(1):13-22. doi: 10.1016/j.bjae.2023.10.005. Epub 2023 Nov 29. No abstract available.
- Background: PubMed 39516501Radkowski P, Rusc J, Keska M. Comparison of measurements obtained with TOF-Cuff placed on the arm and the TOF-Scan on the adductor pollicis muscle during general anaesthesia using mivacurium: a prospective observational clinical trial. Sci Rep. 2024 Nov 8;14(1):27180. doi: 10.1038/s41598-024-76086-6.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Özge Cihangir Özek, MD principal investigator
Abdurrahman YAOTRH
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Gynecologic Cancer and Neuromuscular Blockade, run by Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 9 Nov 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Özge Cihangir Özek, MD (05064969856, ozgecihangirozek@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Time to Neuromuscular Recovery (TOF Ratio >= 0.90) (time frame: From the exact moment of Sugammadex administration up to endotracheal extubation (approximately 10 to 20 minutes).). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07925463, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Nov 2026.