CPT® Code 0312T

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1. Indications

The vagus nerve blocking therapy (VBLOC) is indicated for patients suffering from morbid obesity. This condition is characterized by an excessive amount of body fat that presents significant health risks, including but not limited to diabetes, hypertension, and cardiovascular diseases. The therapy aims to assist in weight management by altering the signals of hunger and satiety transmitted through the vagus nerve.

• Morbid Obesity Patients with a body mass index (BMI) typically greater than 40, or greater than 35 with obesity-related comorbidities, may be considered for this procedure.

2. Procedure

The procedure for vagus nerve blocking therapy involves several key steps that are performed laparoscopically to minimize recovery time and complications.

• Step 1: Preparation and Anesthesia The patient is positioned appropriately, and general anesthesia is administered to ensure comfort and immobility during the procedure.
• Step 2: Incision and Access A small portal incision is made in the upper abdomen, through which a trocar is inserted. Carbon dioxide is then insufflated to create a pneumoperitoneum, allowing for better visualization and access to the abdominal cavity.
• Step 3: Additional Incisions Two to three additional small incisions are made in the upper abdomen to facilitate the introduction of surgical instruments necessary for the procedure.
• Step 4: Laparoscope Introduction A small incision is made just above the umbilicus, and a laparoscope is introduced through this port to provide visual guidance during the surgery.
• Step 5: Exposure of the Esophagogastric Junction The liver is retracted to expose the esophagogastric junction, allowing for the precise placement of the electrode arrays.
• Step 6: Electrode Array Placement Under laparoscopic visualization, the electrode arrays are introduced and secured around the anterior and posterior trunks of the vagus nerve at the distal aspect of the esophagus.
• Step 7: Neuroregulator Connection The leads from the electrode arrays are attached to the neuroregulator and tested to ensure proper function before proceeding.
• Step 8: Pulse Generator Pocket Creation A subcutaneous pocket is created for the pulse generator. A skin incision is made on the side of the body, usually over the lower ribs, and carried down to the subcutaneous tissue.
• Step 9: Neuroregulator Placement A pocket is fashioned, and the neuroregulator is placed within this pocket. The leads are then tunneled to the neuroregulator, connected, and tested again for functionality.
• Step 10: Securing Leads and Closing Incisions The leads are secured in the subcutaneous tissue, and the skin is closed over the neuroregulator to complete the procedure.
• Step 11: Activation and Programming Finally, the neuroregulator is activated and programmed using a transmit coil and an external mobile charging unit to ensure it delivers the necessary electrical stimulation.

3. Post-Procedure

After the vagus nerve blocking therapy, patients are typically monitored for any immediate complications related to the procedure. Post-operative care may include pain management, instructions for activity restrictions, and follow-up appointments to assess the effectiveness of the therapy. Patients may experience some discomfort at the incision sites, which is expected to resolve over time. The programming of the neuroregulator may require adjustments during follow-up visits to optimize the therapy's effectiveness in managing hunger signals.