Children with congenital central hypoventilation syndrome (CCHS) lack a respiratory drive, especially during quiet sleep. These patients require mechanical ventilation during sleep via tracheostomy. Diaphragmatic pacing via phrenic nerve stimulation allows weaning from mechanical ventilation. We describe the thoracoscopic placement of phrenic nerve stimulators.

Using single lung ventilation, 3 trocars were used to dissect the phrenic nerve. A stimulating electrode was sutured around the nerve and tunneled through the diaphragm into a subcutaneous pocket in the upper abdomen. A receiver unit was attached. An external pacing antenna stimulated diaphragm contraction. Once one hemithorax was completed, the patient was repositioned to place the contralateral stimulator.

16 patients underwent successful bilateral thoracoscopic phrenic nerve electrode placement (1997-2006). Mean age was 6.6 years (3-20). Mean procedure time was 3.3hrs (2.5-4.6). ICU stay was 2 days (1-5) and total stay was 5 days (3-7). At 47 month follow up (4-84), 8 patients are decannulated, completely weaned from ventilation and paced only at night. 8 are paced during the day and ventilated only at night. Complications included 2 post surgical infections requiring electrode replacement and 6 internal lead malfunctions.

Thoracoscopic placement of phrenic nerve electrodes is safe and effective in CCHS.