Is capsulectomy a feasible and useful measure in internal pulse generator replacement procedures? A technical note on the use of the PEAK PlasmaBlade^TM

Background: Implantable pulse generator (IPG) replacement is considered a simple procedure, but in case of extension cable damage or IPG pocket infection, it can dramatically affect a patient’s quality of life. Higher risk of infection has been reported after IPG replacement procedures rather than after primary deep brain stimulation lead implantation, and some authors suggested that the IPG pocket capsule could play a pivotal role in causing it. In this technical note we present a capsulectomy technique adopted in IPG replacement procedures. Methods: Between July and October 2015, we carried out ten outpatient IPG replacement procedures at the chest and abdomen under local anesthesia for battery depletion using the PEAK PlasmaBlade^TM. All patients were followed for at least 2 months to rule out any hardware malfunction and infection. Results: All ten procedures were uneventful. No extension cable damage occurred. No IPG pocket infection occurred, also not in the follow-up. Mean surgical time was 30 min. Conclusions: Complete capsulectomy is not feasible with basic surgical instruments, and the PEAK PlasmaBlade^TM pencil appears to be a helpful tool in carrying out the procedure.