Sacral nerve stimulation lead implantation using the o-arm

BMC Urology

Technical Advance

Markku H Vaarala¹  Pertti Finnilä¹  Pekka A Hellström¹  Jani Katisko¹ 

[1] Division of Operative Care and Medical Research Center, Oulu University Hospital, P.O. Box 20, 90029 OYS, Oulu, FIN, Finland;

关键词: Transcutaneous electric nerve stimulation;    Prostheses and implants;    Bladder;    Colon;    Image-guided surgery;    Intraoperative imaging;   

DOI  :  10.1186/1471-2490-13-48

 received in 2013-08-12, accepted in 2013-10-14,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundSacral neuromodulation operations have usually been performed based on 2D fluoro images. However, sacral nerve stimulation lead implantation may be challenging when the normal anatomy is confused by obesity or congenital anomalies. Thus the surgical navigation and intraoperative imaging methods could be helpful as those same methods have proven to be feasible methods for guiding other surgical operations. Our recent knowledge about the O-arm in trauma pelvic operations encouraged us to evaluate the usefulness of O-arm guided navigation in sacral neuromodulation. Similar navigation would be useful for complex sacral nerve stimulation lead implantations.MethodsIn this preliminary article we report our experience of utilizing the orthopedically optimized O-arm to implant the S3 stimulation electrode in a patient. The 3D O-arm imaging was performed intraoperatively under surgical navigation control. General anesthesia was used. The obtained 3D image dataset was registered automatically into the patient’s anatomy. The stimulation needle was guided and the tined lead electrode was implanted using navigation.ResultsThe bony sacral structures were clearly visualized. Due to automatic registration, the navigation was practicable instantly after the O-arm scanning and operation could be performed successfully under navigation control.ConclusionsTo our knowledge, this is the first published tined lead implantation which was guided based on the surgical navigation and intraoperative O-arm images. In this case, the applied method was useful and helped the surgeon to demarcate the region of surgical interest. The method is slightly more invasive than the formal technique but could be an option in anatomically challenging cases and reoperations. However, further evaluation with larger patient series is required before definitive recommendations can be made.

【 授权许可】

Unknown   
© Hellström et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.