Hypoglossal nerve stimulator implantation via a 2-incision technique

A hypoglossal nerve stimulator currently available for clinical use requires 3 incisions to implant 3 separate components. A substantial modification to operative technique described herein moves the device's respiratory sensing lead from the fifth to the second intercostal space, now inserting it transpectorally through the same incision used for the implantable pulse generator. Elimination of a third incision and second lead tunneling procedure minimizes the risk of breast and chest wall injury, reduces operative time, and decreases postoperative pain. Over 60 hypoglossal nerve stimulators have been implanted by the authors using this new technique without complication. Relevant anatomy, dissection boundaries, and surgical technique are also described.