Thoracoscopic placement of phrenic nerve electrodes for diaphragmatic pacing in children

Donald B. Shaul, Paul D. Danielson, J. Gordon McComb, Thomas G. Keens

Research output: Contribution to journalArticlepeer-review

Abstract

Background/Purpose: Diaphragmatic pacing can provide chronic ventilatory support for children who suffer from congenital central hypoventilation syndrome (CCHS) or cervical spinal cord injury. The authors report a new thoracoscopic approach for establishing diaphragm pacing. Methods: Between 1997 and 2000, 9 children ranging in age from 5 to 15 years and suffering from these disorders underwent thoracoscopic placement of bilateral phrenic nerve electrodes. A 3- or 4-trocar technique was used to dissect the phrenic nerve in the midchest and suture a phrenic nerve electrode (Avery Laboratories 1-110A, Commack, NY) into place. The electrode was tunneled to a subcutaneous pocket in the upper abdomen and attached to an implanted pacing unit. Results: Bilateral electrodes were placed successfully into all patients. The average procedure time was 3.3 hours (range, 2.5 to 4.6), and average hospital stay was 4.2 days (range, 3 to 5). Four patients experienced postoperative complications (pneumonia, atelectasis, bradycardia, and pneumothorax). Average follow-up has been 30 months (range, 15 to 49). Eight patients have reached their long-term pacing goals. Conclusions: Phrenic nerve electrodes can be implanted thoracoscopically and allow the successful use of diaphragmatic pacing therapy. Avoidance of thoracotomy with its associated perioperative morbidity and scarring may encourage wider utilization of diaphragmatic pacing in children.

Original languageEnglish (US)
Pages (from-to)974-978
Number of pages5
JournalJournal of pediatric surgery
Volume37
Issue number7
DOIs
StatePublished - 2002
Externally publishedYes

Keywords

  • Congenital central hypoventilation syndrome
  • Diaphragm pacing
  • Thoracoscopy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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