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. 2021 Sep;32(9):2549-2551.
doi: 10.1007/s00192-020-04614-9. Epub 2021 Jan 8.

Sacral neuromodulation: troubleshooting needle placement

Whitney K Hendrickson  1 , Cindy L Amundsen  2
Affiliations

Sacral neuromodulation: troubleshooting needle placement

Whitney K Hendrickson et al. Int Urogynecol J. 2021 Sep.

Abstract

Introduction and hypothesis: The objective was to develop an instructional video that utilizes fluoroscopic images and anatomical landmarks to increase the surgeon's ability to troubleshoot optimal placement of the foramen needle and lead during a stage I sacral neuromodulation (SNM) procedure.

Methods: Eight different examples of suboptimal foramen needle placement with subsequent corrections during a SNM procedure were performed and recorded on a fresh female cadaver.

Results: Fluoroscopic images were obtained during the procedure, and illustrations of the posterior aspect of the sacrum highlighting the S3 foramina and nerve are shown for anatomical comparison.

Conclusions: This video demonstrates how to efficiently identify and correct suboptimal foramen needle placement in order to obtain optimal lead placement during an SNM procedure. Understanding the relationship between the bony landmarks on fluoroscopy and the S3 nerve and foramen are important in order to understand how to correct a suboptimal foramen needle and thus achieve optimal lead placement.

Keywords: Fecal incontinence; Optimal lead placement; Overactive bladder; Sacral neuromodulation; Sacral neurostimulation; Urgency incontinence; Urinary retention.

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References

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