Is monopolar electrocautery use in vagus nerve stimulator revision surgery a risk to avoid or a safe surgical option?

The use of monopolar electrocautery in vagal nerve stimulator (VNS) revision surgeries has been debated due to concerns about device interference. Thus, herein, we aimed to evaluate the safety and efficacy of monopolar electrocautery during VNS generator replacement surgeries, particularly its impact on seizure control and battery performance.

A retrospective observational study was conducted on 30 patients who underwent VNS generator revision at a tertiary care center. Patients were divided into two groups: those in whom monopolar electrocautery was used (n = 18) and those in whom it was not used (n= = 12). Pre- and postoperative data were collected, including seizure frequency, VNS settings, and operative time. The McHugh Outcome Classification was used to assess seizure control.

The surgeries were significantly shorter in the electrocautery group than in the nonelectrocautery group (20.06 ± 2.29 vs. 51.83 ± 12.76 min, p < 0.001). Furthermore, there was no significant difference in seizure control between the two groups (p > 0.05). In two patients, a decline in seizure control classification was noted. However, this did not reach statistical significance. No lead damage or major complications developed in either group.

Monopolar electrocautery significantly reduces the operative time during VNS generator revisions without compromising seizure control or increasing the risk of complications. Thus, monopolar electrocautery can be safely used in VNS revision surgeries, potentially streamlining the procedure and improving patient outcomes. However, further studies with larger populations are needed to confirm these findings.