TABLE OF CONTENTS

Introduction

Device

Benefits of Pacing

Demographics of Pacing

Laproscopic Technology

The Future

Links for More Information

The Group

BI108 Website

Brown University

Sugrical Procedure

Procedure Surgical Risks Conditioning References

Procedure
1. A small (4cm) incision is made just above the clavicle. The subcutaneous tissue is dissected down until the anterior scalene muscle has been exposed. Patient prepared for surgery

2. Assisted by monopolar electrical stimulation, the phrenic nerve is identified over the scalene muscle.

3. The nerve sheath of the phrenic nerve is carefully exposed for about 1cm through an operative microscope.

 Phrenic Nerve Exposed
4. The electrode lead is place along side the nerve and fixed to the surrounding connective tissues with two sutures. Phrenic Electrode in Place

5. A second incision is made into the anterior upper chest, and the receiver placed subcutaneously. The lead is then tunneled and from the electrode down to the receiver.

6. Both incisions are closed, and the procedure is then repeated on the other side of the chest.



  • Patients are always placed in the Intensive Care Unit for management of their ventilation
  • Prophylactic antibiotics are continued for 48 hours


    • Surgical Risks

  • Invasive surgery carries increased risk of infection, as does long hospital stay
  • High risk of damage to the phrenic nerves due to phrenic nerve dissection and electrode placement


    • Conditioning

  • Because the patients have atrophied diaphragm muscles doctors must condition them after the device is implanted before the patients can be weaned from the ventilator.
  • Conditioning is achieved by electrically stimulating the diaphragm for 10 to 15 minute intervals until the muscle is rendered capable of responding to the external battery control of the device for extended periods of time.


    •  References
    Surg Neurol. 2003 Feb; 59(2): 128-32; discussion 132.
    http://www.medtech1.com/new_tech/newtechnologyfeature.cfm/113/1
    http://mediswww.meds.cwru.edu/public_affairs/medlines/01may.pdf