Vagal Nerve Blocking Therapy for Weight Loss: Laparoscopic Technique for Placing Neuroregulator and Leads

Video Type: CVideo
  • 2-5 min videos of a particular surgery or technique. These again show major events in the surgery
  • Clearly annotated and narration is a must in these videos
  • These have clear but concise abstracts are not able to be indexed in PubMed
  • Distributed in newsletters, featured on our website and social media
  • Peer reviewed

Author: Nova Szoka
Published:
Specialties: General Surgery
Schools: Duke University
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Basic Info

Contributors: Shaina Eckhouse, Daniel Guerron, Keri Seymour, Ranjan Sudan , Jin Yoo, Chan Park , and Dana Portenier.

The present video illustrates the technique utilized to place a vagal nerve stimulator for weight loss in a morbidly obese patient. As most surgical trainees do not routinely perform truncal vagotomy, laparoscopic or otherwise, the technical goal of this video is to depict the surgical technique needed to laparoscopically identify and work with the anterior and posterior vagus nerves.  Vagal nerve blocking therapy is one of many procedures used for surgical weight loss. In the present case, the weight loss achieved was less than that seen with a gastric bypass or sleeve gastrectomy over a comparable time period.

Advanced

Procedure

The procedure was initiated under general endotracheal anesthesia. The abdomen was insufflated, and a camera and working ports were placed. A Nathanson liver retractor was placed. Upon inspection, no hiatal hernia was identified. Using a combination of blunt dissection and bipolar energy device, the anterior and posterior vagal trunks were identified and isolated. The first vagal nerve blockade lead was introduced into the abdomen and placed around the posterior vagus nerve, and the lead tip was sutured to the esophagus with a 2-0 silk suture. The second lead was placed around the anterior vagus nerve and sutured in a similar manner. A 4cm skin incision inferior to left rib cage was made, and a subcutaneous pocket was created anterior to the ribs for the rechargeable neuroregulator. The leads were then retrieved from inside the abdomen and coupled to the battery pack. The impedance of the leads and the neuroregulator were tested and noted to be within therapeutic range. The neuroregulator was then anchored to the abdominal wall fascia. The leads were then completely internalized laparoscopically. The procedure took 99 minutes with an estimated blood loss of 5 mL. The patient was discharged home on post-operative day 1 doing well.

Indications

Morbid obesity

Contraindications

Patient's who are poor surgical candidates. History of prior vagotomy.

Instrumentation

Setup

Less invasive approaches to bariatric surgery are becoming more popular and available to the growing population of morbidly obese patients. The vagal nerve blockade offers a reversible option for weight loss by stimulating early satiety and decreasing overall intake per os. The present video demonstrates the feasible technique for placing the neuroregulator and leads for vagal nerve blockade.

Preoperative Workup

A 61-year-old morbidly obese female with a body mass index (BMI) of 41 presented for bariatric surgery evaluation. After undergoing her evaluation and learning about the surgical options, the patient was most interested in a weight loss surgical option that was reversible. Because the patientâs history, the patient was counseled, posted, and consented on the laparoscopic vagal nerve blockade.

Anatomy and Landmarks

Not Available

Advantages/Disadvantages

Limited data available on excess weight loss (%EWL) associated with this procedure, one study reports 21%EWL at 2 years.

Complications/Risks

Implantation of foreign body can lead to complications such as lead dislodgement, scarring in left upper quadrant, infection, bowel obstruction.

Disclosure of Conflicts

Implantation of foreign body can lead to complications such as lead dislodgement, scarring in left upper quadrant, infection, bowel obstruction.

Acknowledgements

none

References

1. Apovian CM, Shah SN, Wolfe BM, Ikramuddin S, Miller CJ, Tweden KS, Billington
CJ, Shikora SA. Two-Year Outcomes of Vagal Nerve Blocking (vBloc) for the
Treatment of Obesity in the ReCharge Trial. Obes Surg. 2017 Jan;27(1):169-176.
2. https://vbloc.com/

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