Non-invasive massage technique to aid in removal of a tined sacral neuromodulation lead

Abstract

Introduction and hypothesis: Describe a novel technique for retrieval of the Interstim lead in part based on techniques used in massage therapy. Methods: Retrospective review of patients (single surgeon) identified by CPT code 64585 over 10 years. Exclusion criteria included patients who (1) had explantation for active infection or (2) did not proceed with a stage 2 implant (in the event of a staged procedure). To effect removal, the surgeon applies a focused massage with firm deliberate pressure in deep circular motions to the insertion site and surrounding tissue. At the same time, gentle steady traction is applied to the lead (from the IPG pocket) by the surgeon. Results: Sixty women were identified. Mean implant duration was 24 (6–60) months. There were three lead fractures at retrieval (5%). In all three occurrences, the inner conductor wire was removed despite leaving the tined fragment in place. The author did not perform a cutdown to retrieve the retained fragment. There were no peri- or postoperative complications. Conclusions: Lead removal is safely accomplished in a matter of a few minutes with the presented technique without the need for a cutdown. Lead breakage was 5% and similar to more invasive techniques.