Chronic stimulation of the left vagus nerve (VNS) is commonly performed for different clinical conditions such as refractory epilepsy in children and adults, and major and bipolar depression. Despite more than 20 years of cumulative experience with VNS implantation, various surgery- and modality-related complications continue to occur in a sizable percentage of patients. A clear understanding of surgical anatomy and following standard operating protocol may, at least theoretically, reduce the number of complications. Here we present our way to perform VNS implantation and discuss different kinds of complications that each implanter should be aware of. Technical details of revision surgery are also presented.