The insertion of the stimulator is usually performed under general anesthesia (when the patient is asleep). In most cases, patients will be asked to sign a consent form and to stop eating and drinking after midnight prior to the procedure. Certain medications may need to be reduced or stopped temporarily, so patients should discuss their medication schedules with their neurologist or other physician before surgery. Patients wear a hospital gown for the insertion and will be asked to remove dentures, jewelry, nail polish and/or glasses.

Some surgeons use local anesthetic for the procedure. In these cases, the patient will be awake during the procedure but will not feel any pain.

During the procedure, the surgeon will make two small cuts (incisions). One incision will be made at the neck where the vagus nerve will be accessed. The other incision will be made on the left side of the chest either below the collarbone or at the armpit. The device is then placed by the surgeon under the skin in the chest wall. The small electrodes (leads) connected to the device are carefully threaded up through the patient’s neck. Using the incision in the neck, the surgeon is then able to wrap the ends of the leads around the vagus nerve. The incisions at both sites are closed with stitches. The entire procedure usually takes one or two hours and may be performed as an in-patient or out-patient procedure, typically with hospital discharge on the same day as the surgery.