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Thoracoscopic placement of phrenic nerve electrodes for diaphragmatic pacing in children
Donald B Shaul1, Paul D Danielson, J Gordon McComb
1Department of Surgery, Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Insights
This study introduces a minimally invasive thoracoscopic method for diaphragm pacing in children with CCHS or spinal cord injuries, successfully implanting electrodes in all patients. This approach may increase the use of diaphragmatic pacing by reducing surgical risks.
Area of Science:
- Pediatric Surgery
- Thoracoscopic Procedures
- Respiratory Support
Background:
- Congenital central hypoventilation syndrome (CCHS) and cervical spinal cord injuries necessitate chronic ventilatory support.
- Diaphragmatic pacing is an established method for providing such support.
- Traditional surgical approaches carry significant morbidity.
Purpose of the Study:
- To report a novel thoracoscopic technique for establishing diaphragmatic pacing in pediatric patients.
- To evaluate the feasibility and outcomes of this minimally invasive approach.
Main Methods:
- Nine children (ages 5-15) with CCHS or spinal cord injury underwent thoracoscopic placement of bilateral phrenic nerve electrodes.
- A 3- or 4-trocar technique was employed to dissect and suture electrodes onto the phrenic nerve.
- Electrodes were tunneled to an implanted pacing unit.
Main Results:
- Successful bilateral electrode placement was achieved in all nine patients.
- The average procedure time was 3.3 hours, with an average hospital stay of 4.2 days.
- Eight patients achieved their long-term pacing goals, despite four experiencing minor postoperative complications.
Conclusions:
- Thoracoscopic implantation of phrenic nerve electrodes is a viable method for diaphragmatic pacing.
- This approach avoids thoracotomy, potentially reducing perioperative complications and scarring.
- Wider adoption of diaphragmatic pacing in pediatric populations may be facilitated by this technique.
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 I-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.