Less is more - Retrospective analysis of the two-incision implantation technique for hypoglossal nerve stimulation and comparison of respiratory sensing lead curves against the three-incision technique

Introduction

Breathing-synchronized hypoglossal-nerve stimulation is a treatment option for suitable patients with severe obstructive-sleep-apnoea. The classical implantation technique requires three incisions: submental to place the stimulating-electrode on terminal branches of the hypoglossal-nerve, sub-clavicular to place the impulse generator, and on the lateral chest-wall to place a breathing-sensor lead. A two-incision-technique has been propagated and widely adopted whereby the respiratory-sensing-lead is placed deeper to the IPG-pocket.

Research question

Our department switched to the 2-incision-technique in May 2021 and we set out to compare the two methods concerning the generated respiratory-sensing-curves.

Material and method

Cases operated between October 2020 and September 2022 were included. Parameters included age, gender, BMI, OR time, positioning of the detection-lead, and preoperative Apnoea-Hypopnoea Index (AHI). The generated respiratory-sensing curves were categorized by an independent expert blinded to the surgical-technique regarding conduciveness to optimal stimulation.

Result

21 patients were included. 5 were operated with the 3-incision-technique. Women were underrepresented. There were no further significant differences in patient characteristics. The expert-opinion on the respiratory-sensing-curves did not vary between groups. Mean OR-time was marginally less in the 2-incision group without being statistically significant.

Conclusion

The 2-incision-technique generates respiratory-sensing curves at par with those generated with 3-incision-implants. The limited patient data collected in this analysis suggests that OR-time can be reduced using the 2-incision-technique. There were no cases of postoperative complications in our cohort. It can be postulated that a 2-incision-implant has a lower risk of infection due to the reduced wound-surface.