The ENTRAMI technique: Endoscopic transgluteal minimal invasive technique for implantation of a pudendal electrode under full visual control: A cadaver study

Abstract

Aim: The aim of this article is to describe a minimal invasive trans gluteal endoscopic approach to implant a pudendal electrode for neuromodulation under full visual control. Methods: Eight trans gluteal approaches were performed on four cadavers. The sacral transforaminal percutaneous technique was performed to implant the electrode. The electrode was then picked up and placed under visual control next to the pudendal nerve. Results: The first trocar was placed in the upper lateral quadrant of the gluteal region.The 0°optical system was used to help with the pneumodissection to identify the sciatic nerve. At that point a second 3 mm trocar was placed to insert a dissecting grasping forceps. In some cases, a second 3 mm trocar was placed. A step by step dissection, based on anatomical findings, was necessary to be able to locate the pudendal nerve. The electrode, which was placed percutaneously and transforaminal through S3 or S4, was picked up and placed under full visual control next to the pudendal nerve, slightly entering the Alcock's canal. The electrode was placed in an ideal manner, meaning that all 4-contact points of the electrode are in parallel and in contact with the targeted nerve.The electrode was fixed in that ideal position at the level of the sacrospinous ligament. After placement of that electrode, an X-ray of the pelvic area was done. Conclusions: The ENTRAMI technique allows optimal pudendal electrode placement under full visual control and should now be tested in a clinical setting. K E Y W O R D S electrode, minimal invasive, neuromodulation, pudendal 130 |

Evolving types of pudendal neuromodulation for lower urinary tract dysfunction

“…In 2019, Jottard et al [ 30 ] explored the feasibility of the ENTRAMI technique (sacral transforaminal lead placement under full visual control by trans gluteal endoscopic guidance). In their publication they describe promising feasibility results of 8 dissections with the ENTRAMI technique performed on 4 human cadavers, allowing both PNM and SNM.…”

Laparoscopic selective pudendal neuromodulation for neurogenic bladder: a review of literature

“…In this clinical case report with review of the literature, we described a novel technique of selective placement of an electrode over the PN with laparoscopic approach (LASE/PN), in a patient with urinary retention due to tethered cord syndrome, who previously failed SNM treatment. Different percutaneous with perineal or posterior approaches and transgluteal endoscopic and laparoscopic techniques have been described for pudendal electrode placement [2,3,4]. Li et al effectively performed a bilateral placement with stepwise electric stimulation approaches, however, an endoscopic transgluteal minimal invasive (ENTRAMI) technique can not be accepted as a reproducible approach in practice.…”

Current role of neuromodulation in bladder pain syndrome/interstitial cystitis

“…In 2019, the endoscopic transgluteal minimal invasive technique (ENTRAMI) for implantation of a pudendal electrode was described in cadaveric models, 39 and clinical effectiveness in patients with chronic perineal pain in the pudendal or cluneal nerve area was demonstrated in 15 patients after nerve release. 40 In another pilot study, 16 patients underwent both nerve release and implantation of a PNE lead through a posterior approach with full visual control.…”