Placement of a diaphragm pacemaker involves making small (3-5 cm) incisions in the lower neck. The phrenic nerve is isolated where it is most superficial, which is under the scalenus anticus muscle. The surgeon places the electrode around the nerve and sutures it in place.
The receiver is then placed just under the skin, usually within a small pocket made on the upper part of the chest.
There is also an approach to place the diaphragm pacemaker using incisions in the chest. The neck approach has the advantage that it can be performed on an outpatient basis for some patients.