Nantes Surgeon Pioneers Targeted Muscle Reinnervation for Advanced Prosthetic Control in France

Nantes, France – A fourth patient underwent a groundbreaking surgery at the Jules Verne clinic in late January 2026, bringing France to the forefront of advanced prosthetic technology. The procedure, known as Targeted Muscle Reinnervation (TMR), allows amputees to control bionic prosthetics with greater precision by rerouting nerve signals.

What is Targeted Muscle Reinnervation?

TMR surgery, initially developed in the United States, involves reactivating nerves that once controlled the amputated limb by grafting them onto existing muscles. According to Dr. Edward de Keating-Hart, who introduced the technique to France in 2018, “It consists of recovering the nerves that allowed the amputated patient’s hand and forearm to function. And these nerves…we will reactivate them by grafting them to muscles. These muscles, when they have received the influence coming from the brain and thanks to an electrode, they will for example, reopen the hand, close it or even turn the arm.”

A French First and Collaborative Training

Dr. De Keating-Hart, a surgeon at the Jules Verne clinic, performed the first TMR surgery in France in 2018. While only three operations were conducted between 2018 and 2023, the recent fourth surgery attracted a medical team from Grenoble University Hospital, seeking training in the technique. This highlights Nantes’ position as a leading center for bionic prosthetic research and implementation.

Nantes: A National Center for Bionic Prosthetics

Dr. De Keating-Hart emphasizes the importance of Nantes as the sole center in France specializing in this advanced procedure. “The Nantes bionic center is in any case the nerve center in France because there are no other places,” he stated. He envisions Nantes continuing to drive research and clinical studies, with the potential to establish satellite centers to expand access to care for more patients.

Cost and Reimbursement

Historically, the high cost of bionic prosthetics – ranging from 150,000 to 200,000 euros – has limited access to this technology. However, the recent surgery was fully covered by Health Insurance, a positive development that Dr. De Keating-Hart believes will increase the number of patients benefiting from TMR. He anticipates an increase in surgeries, moving from one patient every two years to two per year.

Beyond Prosthetic Control: Addressing Phantom Limb Pain

TMR surgery offers benefits beyond restoring limb function. Dr. De Keating-Hart notes that it can also effectively reduce and treat phantom limb pain, a debilitating condition that often affects amputees. “It is also an excellent treatment for neuropathic pain (phantom limb pain), which is an extremely unpleasant and very debilitating pain,” he explained.

Dr. Edward de Keating-Hart

Dr. Edward de Keating-Hart is a hand surgeon based in Nantes, France. He holds Diplomas in inter-university surgery of the hand and upper limb, university diploma in micro-surgery, and inter-university diploma in ultrasound of the upper limb. He is a member of the EWAS (European Wrist Arthroscopy Society) and an associate member of the French Society of Surgery of the Hand. He practices at the Jules Verne Clinic located at 2 Route de Paris, 44300 Nantes. His clinic can be reached at 02 40 59 59 86 or via his website: https://www.chirortho-julesverne.fr/Dr-Edward-de-Keating-hart