Minimally invasive sacral neuromodulation implant technique: modifications to the conventional procedure.

PURPOSE: Sacral neuromodulation is a novel treatment for selected urinary and\r\nbowel dysfunctions. A new method is described for electrode implantation, the\r\n"minimally invasive sacral neuromodulation implant technique." METHODS: After\r\nthe percutaneous nerve evaluation test, a small longitudinal incision (3 cm) is\r\nmade, and a catheter cannula segment is inserted through the sacral foramen\r\nbeside an insulated needle. The electrode is introduced into the catheter\r\ncannula, which is then removed and fixed to the sacrum by means of small\r\nanchors. The proximal part of the lead is tunneled into the subcutaneous tissue,\r\nreaching the pocket made to accommodate the neurostimulator. RESULTS: This\r\nprocedure was performed in ten patients (5 male; mean age, 50.4 years). In four\r\npatients a single electrode was implanted, and in six patients two electrodes\r\nwere implanted. The minimally invasive technique was significantly faster,\r\nsaving a mean time of 20 minutes for each electrode. The incision made directly\r\non the sacral foramen was significantly reduced (3 vs. 12 cm), avoiding the\r\nwide, blunt dissection of subcutaneous fat tissue. Application of the catheter\r\ncannula allowed the electrode to be introduced easily and correctly. The\r\nelectrode anchors never failed: no cases of lead displacement or suboptimal\r\nposition of the electrode occurred. A unilateral, sterile subcutaneous seroma\r\noccurred in one of the ten patients. CONCLUSIONS: The minimally invasive sacral\r\nneuromodulation implant technique seems to be a safe procedure-making sacral\r\nneuromodulation implant easier, faster, and safer, in as much as complications\r\ncould be potentially reduced.