Thoracoscopic placement of phrenic nerve electrodes for diaphragmatic pacing in children.
OBJECTIVE
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.
Shaul
Donald B
DB
Department of Surgery, Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Danielson
Paul D
PD
McComb
J Gordon
JG
Keens
Thomas G
TG
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003964:Diaphragm / Q000294:innervation*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010791:Phrenic Nerve; D011182:Postoperative Care; D012189:Retrospective Studies; D020182:Sleep Apnea, Central / Q000151:congenital* / Q000628:therapy*; D013906:Thoracoscopy / Q000379:methods*