Diaphragm pacing using the minimally invasive cervical approach

The Journal of Spinal Cord Medicine, 2023 · DOI: 10.1080/10790268.2021.1940794 · Published: June 18, 2021

Spinal Cord Injury Pulmonology Neurology

Simple Explanation

This paper discusses a minimally invasive surgical technique, the cervical approach, for implanting diaphragm pacers, which help patients breathe without needing mechanical ventilation. The cervical approach involves placing electrodes on the phrenic nerve in the neck through a small incision, avoiding the need to enter the chest or abdomen. The study compares the cervical approach to other methods like thoracotomy and laparoscopy, finding it offers advantages such as the potential for local anesthesia and reduced perioperative complications.

Study Duration

Not specified

Participants

1,522 subjects

Evidence Level

Retrospective review

Key Findings

1
The cervical approach for diaphragm pacer implantation is the most minimally invasive technique.
2
Devices implanted cervically show no significant difference in their longevity than those implanted using the thoracic approach.
3
17% of cervically placed electrodes required at least one replacement compared to 18% of electrodes placed thoracically.

Research Summary

The study reviews the cervical approach for implanting phrenic nerve/diaphragm pacers as a minimally invasive technique, comparing it to intrathoracic and sub-diaphragmatic approaches. Results from a database of 1,522 patients implanted with Avery diaphragm pacers showed that the cervical approach is underutilized despite its advantages, such as the possibility of using local anesthesia and avoiding body cavity entry. The study concludes that the cervical approach should be considered in appropriate patients to reduce perioperative morbidity, with no significant difference in device longevity compared to the thoracic approach.

Practical Implications

Surgical Technique Choice

Surgeons should consider the cervical approach for diaphragm pacer implantation to minimize invasiveness and potentially reduce perioperative morbidity, especially in older patients or when local anesthesia is preferred.

Patient Airway Management

Anesthesiologists should plan airway management based on the patient's respiratory function and the chosen surgical technique, with the cervical approach potentially allowing for monitored anesthesia care in select patients.

Device Longevity

Clinicians can expect similar device longevity regardless of whether the cervical or thoracic approach is used for diaphragm pacer implantation.

Study Limitations

1
Retrospective study design
2
Data limited to Avery Biomedical Devices database
3
Lack of specific details regarding patient selection criteria for each surgical approach

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