Augmentation of the accuracy of percutaneous electrode implantation by using a modified arthroscope to guide...

Using a clear polyvinyl fluoride sheath over an arthroscope, inserted through a 1-cm stab incision, we have demonstrated the feasibility of visualizing the sciatic nerve and its branches in the feline model. The purpose of this technique is to allow visual control, without a large surgical incision, of the exact site of implantation of electrodes used for functional neuromuscular stimulation. Currently, we determine the optimum site for percutaneous electrode implantation by stimulating the target nerve or muscle with a 26-gauge probe needle until maximal response is obtained. This method lacks accuracy because there is no direct visualization of the location of the tip of the probe or the electrode. With the new technique, we identified nerves by their distinctive vascular markings and we followed the nerves with minimal disruption of the soft tissues. In this way, individual branches were identified and targeted for instrumentation, allowing selective stimulation of specific muscle groups.