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Thursday, November 14, 2013

An interesting surgical question and professional response…

Through the years that I have been involved with VNS Therapy for depression I have been extremely fortunate to have the aid of many expert and knowledgeable medical professionals who have taken of their valuable time to answer my questions, further educate me in my support and advocacy for Joyce and other patients, and depending upon the circumstances have allowed me to share their responses publicly or otherwise.

Once again, I would like to thank Dr. Werner Doyle for his prompt response to a question asked of me just recently by another VNS depression patient. I was unable to share any of my knowledge on the subject. Dr. Doyle has now shared his expertise and thoughts and I in turn share with you the readers in the following email communications.




From: Herbert Stein []
Sent: Wednesday, November 13, 2013 4:09 PM
To: Dr. Badih Afif Adada; Dr. Werner Doyle; Dr. Istvan Takacs
Subject: VNS Surgical Question...

Dear Drs. Adada, Doyle and Takacs,

I was recently questioned by a VNS patient for depression.  One of the very few times I was not qualified or knowledgeable and therefore unable to answer the question factually so I am turning to you fellows for assistance.

I would appreciate if any of you outstanding surgeons could answer my question and if at the same time you would allow me to publicly share your respective response(s) and information?

The patient is coming due for a replacement generator.  The patient was originally implanted with a single incision just below the left collarbone.  At the time of replacement for this particular patient would the operating surgeon handling the replacement surgery re-enter through the exact same incision to remove and replace the existing pulse generator or would the surgeon have need to create a new entry point?

Your knowledgeable responses would be gratefully appreciated.



Joyce and Herbert Stein

1008 Trailmore Lane

Weston, FL 33326-2816

(954) 349-8733




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From: Werner Doyle []
Sent: Thursday, November 14, 2013 6:48 AM
To: Herbert Stein
Subject: Re: VNS Surgical Question...

Dear Mr. Stein,

Generally revisions (replacements, etc.) are performed through the same incision. I never favored the single incision procedure since it is located  in a cosmetically unacceptable location, requires that the incision be much larger than the alternative approaches, and one can not if appropriate place the generator subpectorally. The single incision is just not cosmetically good nor is it surgically efficient. It is not possible to be completely sure about how to approach this issue unless I see the incision and the specific anatomical circumstance. Most likely replacing the generator is an easy task by using the old incision line.


Werner Doyle

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