Abstract
Background
We present here the first reported cases of patients undergoing gastric bypass with a hybrid technique that involves a new concept of percutaneous instruments and provides the advantages of minimally invasive single-port surgery while maintaining the triangulation, safety, and timing of operative procedures.
Methods
This was a prospective pilot study of eight patients selected for gastric bypass between December 2011 and January 2012 and treated by a technique that combined single SSL port and percutaneous surgical set PPS. We performed hand-sewn gastrojejunostomy in all cases. We analyzed preliminary results at 1 month and focused on the feasibility of the technique, duration of surgery, perioperative complications, and cosmetic results. The Ethics Committee of our institution approved this study and we obtained the informed consent of each patient.
Results
We completed the procedure successfully in all patients. No conversions to laparotomy or classic laparoscopy were required. The average time of surgery was 112 min (85–155). Length of hospital stay was 4 days (3–5). One patient was re-admitted on the seventh postoperative day for gastrointestinal bleeding from the gastrojejunostomy suture and treated by endoscopic clipping. Residual scars were less than 2 cm for the single midline port and 2 mm for the percutaneous instruments.
Conclusions
This new technique combines the advantages of single-port surgery with the safety of conventional laparoscopy by using percutaneous instruments and leaves minimal scarring. It is likely that the use of percutaneous instrumentation will become widespread in all areas of laparoscopic surgery.
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References
Reoch J, Mottillo S, Shimony A, et al. Safety of laparoscopic vs open bariatric surgery: a systematic review and meta-analysis. Arch Surg. 2011;11:1314–22.
Puzziferri N, Austrheim-Smith IT, Wolfe BM, et al. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg. 2006;2:181–8.
Tacchino RM, Greco F, Matera D, et al. Single-incision laparoscopic gastric bypass for morbid obesity. Obes Surg. 2010;8:1154–60.
Navarra G, Pozza E, Occhionorelli S, et al. One-wound laparoscopic cholecystectomy. Br J Surg. 1997;84:695.
Auyang ED, Santos BF, Enter DH, et al. Natural orifice translumenal endoscopic surgery (Notes(®)): a technical review. Surg Endosc. 2011;10:3135–48.
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors. JAMA. 2003;289:76–9.
Dietel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg. 2003;13:329–30.
Sjöström L, Lindroos AK, Peltonen M, et al. Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.
Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2008. Obes Surg. 2009;12:1605–11.
Misawa T, Sakamoto T, Ito R, et al. Single-incision laparoscopic splenectomy using the “tug-exposure technique” in adults: results of ten initial cases. Surg Endosc. 2011;10:3222–7.
Makino T, Milsom JW, Lee SW. Feasibility and safety of single-incision laparoscopic colectomy: a systematic review. Ann Surg. 2012;255:667–76.
Flora ED, Wilson TG, Martin IJ, et al. A review of natural orifice translumenal endoscopic surgery (NOTES) for intra-abdominal surgery: experimental models, techniques, and applicability to the clinical setting. Ann Surg. 2008;4:583–602.
St Peter SD, Adibe OO, Juang D, et al. Single incision versus standard 3-port laparoscopic appendectomy: a prospective randomized trial. Ann Surg. 2011;4:586–90.
Bulut O, Nielsen CB, Jespersen N. Single-port access laparoscopic surgery for rectal cancer: initial experience with 10 cases. Dis Colon Rectum. 2011;7:803–9.
Brinkmann L, Lorenz D. Minilaparoscopic surgery: alternative or supplement to single-port surgery. Chirurg. 2011;5:419–24.
Paek J, Nam EJ, Kim YT, et al. Overcoming technical difficulties with single-port access laparoscopic surgery in gynecology: using conventional laparoscopic instruments. J Laparoendosc Adv Surg Tech A. 2011;2:137–41.
Lai EC, Yang GP, Tang CN, et al. Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg. 2011;3:254–8.
Huang CK, Yao SF, Lo CH, et al. A novel surgical technique: single-incision transumbilical laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2010;10:1429–35.
Saber AA, El-Ghazaly TH, Minnick DB. Single port access transumbilical laparoscopic Roux-en-Y gastric bypass using the SILS port: first reported case. Surg Innov. 2009;4:343–7.
Bruner TW, Salazar-Reyes H, Friedman JD, et al. Umbilical hernia repair in conjunction with abdominoplasty: a surgical technique to maintain umbilical blood supply. Aesthet Surg J. 2009;4:333–4.
Conflict of Interest
There is a consulting agreement between Ethicon Endo-Surgery and Anne-Catherine Dandrifosse (Mdeon Visa Number 11/V1/3863/038209). Dr. Dandrifosse provides this service free of charge and does not, and will not, receive monetary compensation from EES.
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Kotzampassakis, N., Machairas, N., Clanet, M. et al. Initial Experience of Single-Port Surgery Assisted by Percutaneous Instruments for Gastric Bypass: a Combination of Safety and Minimally Invasive Surgery. OBES SURG 23, 267–271 (2013). https://doi.org/10.1007/s11695-012-0793-y
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DOI: https://doi.org/10.1007/s11695-012-0793-y