title: Minimally invasive sacral neuromodulation implant technique: modifications to the conventional procedure.
abstract: OBJECTIVE
  Sacral neuromodulation is a novel treatment for selected urinary and bowel dysfunctions. A new method is described for electrode implantation, the "minimally invasive sacral neuromodulation implant technique."
  
  
  METHODS
  After the percutaneous nerve evaluation test, a small longitudinal incision (3 cm) is made, and a catheter cannula segment is inserted through the sacral foramen beside an insulated needle. The electrode is introduced into the catheter cannula, which is then removed and fixed to the sacrum by means of small anchors. The proximal part of the lead is tunneled into the subcutaneous tissue, reaching the pocket made to accommodate the neurostimulator.
  
  
  RESULTS
  This procedure was performed in ten patients (5 male; mean age, 50.4 years). In four patients a single electrode was implanted, and in six patients two electrodes were implanted. The minimally invasive technique was significantly faster, saving a mean time of 20 minutes for each electrode. The incision made directly on the sacral foramen was significantly reduced (3 vs. 12 cm), avoiding the wide, blunt dissection of subcutaneous fat tissue. Application of the catheter cannula allowed the electrode to be introduced easily and correctly. The electrode anchors never failed: no cases of lead displacement or suboptimal position of the electrode occurred. A unilateral, sterile subcutaneous seroma occurred in one of the ten patients.
  
  
  CONCLUSIONS
  The minimally invasive sacral neuromodulation implant technique seems to be a safe procedure-making sacral neuromodulation implant easier, faster, and safer, in as much as complications could be potentially reduced.
authors.affiliation: Department of Clinica Chirurgica, Catholic University, Largo A. Gemelli 8, 00168 Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ratto
authors.forename: Umberto
authors.initials: U
authors.lastname: Morelli
authors.forename: Stefania
authors.initials: S
authors.lastname: Paparo
authors.forename: Angelo
authors.initials: A
authors.lastname: Parello
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Doglietto
mesh_terms: D003248:Constipation / Q000503:physiopathology / Q000601:surgery*; D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D014555:Urination Disorders / Q000503:physiopathology / Q000601:surgery*