The sacral LION procedure for recovery of bladder/rectum/sexual functions in paraplegic patients after explantation of a previous Finetech-Brindley controller

Abstract

Study objective: To report on our technique of sacral laparoscopic implantation of aneuroprosthesis-LION procedure-for recovery of bladder/intestinal/sexual function in paralyzed patients after spinal cord injury.

Design: Prospective case series report.

Setting: Academic community teaching hospital.

Patients: Eight consecutive complete T-paralyzed patients after explantation of a previous dorsal implanted Brindley-Finetech controller with a sacral deafferentation.

Interventions: Laparoscopic transperitoneal exposure of the sacral plexuse and bilateral implantation of Brindley-Finetech electrodes to the sacral nerve roots S2 to S4.

Measurements and main results: Feasibility, complications, and outcome of the procedures. In 6 patients, recovery of electrically induced micturition and defecation could be obtained and in 2 men recovery of electrically induced erection. In 2 other patients, exposure and intraoperative stimulation of the sacral nerve roots showed irreversible destruction of the motoric vesical and rectal nerves. In one, the bilateral implantation of neuromodulation electrodes permitted complete control of the spasticity of the lower limbs and to the autonomic dysreflexia.

Conclusion: The laparoscopic transperitoneal approach offers minimally invasive access for implantation of electrodes to the sacral nerve roots in paralyzed patients for recovery of pelvic visceral functions after failure of a previous implanted dorsal Brindley-Finetech controller with sacral deafferentation.