Surgical details

The phrenic nerves arise at both sides from the cervical segments 3 through 6 of the spinal cord. Approach to the phrenic nerves is with minimally invasive thoracotomy, or with manual or robotic thoracoscopic techniques. The shortest way from the surface of the skin to the whole nerve is through the second intercostal space (between the second and the third rib) just outside of the borders of the sternum on both sides. On the right side the nerve almost exactly drops vertically down from the clavicular groove to the center of the right diaphragm. On the left side, the nerve has to follow laterally the outer line of the heart but also ends in the center of the diaphragm. The center of the diaphragm is a tendon plate, which is fixed to the lower rib cage by the diaphragm muscles. Electrode matrix with 4 embedded Platinum contacts is fixed intrathoracically on the sides of the intact phrenic nerve trunk. No mechanical stress is present on the nerve. No special tools are needed during the implantation procedure.

A cervical approach may be justified in some cases due to anatomical reasons.


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