Optimizing electrode implantation in sacral nerve stimulation—an anatomical cadaver study controlled by a laparoscopic camera

Abstract

This study allows direct visualization during the placement of the needle and electrode, thus permitting accurate calculations of the best angle of approach during the surgical procedure in sacral nerve stimulation. These objective findings attempt to standardize this technique, which is often performed with the aid of intra-operative fluoroscopy but still leaving a lot to chance. These insertion angles should help to find more consistent and reproducible results and thus improved outcome in patients.

The technique of sacral nerve modulation

“…reported a median angle of needle entry into the S3 foramen of 69° (45–90) in the sagittal plane and Buchs et al . reported this to be 62.9 ± 3° (59–70). No gender‐related differences were noted (Fig.…”

Third Sacral Foramina Morphometry for Sacral Neuromodulation

“…2 It is difficult to determine for sure if this small difference in reported S3 angles represents the soft tissue distortion commonly associated with supine storage of cadavers, the small population size of the cadaveric study, or a true nonparallel relationship of the skin and dorsal sacrum in live patients. A small cadaveric study (n = 5) recommended a needle insertion angle of approximately 60 degrees relative to the skin and found that acute angles (near 50 degrees) were more likely to be malpositioned.…”

Neuromodulation for intractable OAB

“…In addition, some researchers challenge the currently dominant concept concerning stimulation of the S3 nerve root, suggesting that in some patients S4 stimulation may be used as either salvage or first option, as it might be associated with lesser risk of leg pain whilst still achieving sufficient pelvic floor contractions and perianal sensations 16. Novel approaches in SNM, such as pudendal nerve stimulation, suggest that S2 stimulation is also associated with good clinical outcomes 21, 22 …”