Abstract
Background
Single-site laparoscopic surgery is a promising emerging technique with potential to decrease postoperative pain, reduce port-site complications, and improve cosmetic results. Laparoscopic adjustable gastric banding (LapGB) is a procedure that lends itself well to single-site laparoscopic surgery because the surgery is confined to a single region of the body, the need for a larger incision for port implantation and the fact that bariartric patients are more likely to be body image conscious. The procedure is, however, technically challenging and potentially more time consuming and hazardous. To simplify learning, a hybrid technique that used multiple conventional trocars and laparoscopic equipment through a single periumbilical incision while retaining the use of the Nathanson retractor via a separate epigastric incision was developed. The authors’ experience and results with this technique are described.
Methods
This retrospective review describes the prospectively collected data for the first 60 consecutive cases completed using the minimally invasive technique described.
Results
The 60 cases in this study comprised 12 men and 48 women with an average age of 39 years (range 20–59 years). Their average body mass index (BMI) was 39.1 kg/m2 (range 32–52 kg/m2). Four patients (6.7%) needed an additional port either for hemostasis or for access difficulties. Concomitant hiatal hernia repair was performed for 13 patients. Five patients (8.3%) had superficial wound infection requiring oral antibiotic therapy and dressings. No other complications were observed. Overall, the average operating time was 55 min (range 30–160 min). For both surgeons, the learning curve was six cases, with a significant difference in the operating times between the first six cases and the remaining cases (p < 0.0001, Mann–Whitney U test).
Conclusions
The authors’ early experience with the minimally invasive LapGB technique shows that it is feasible and safe. It can be used either as a bridging technique to single-site LapGB or on its own as a minimally invasive technique.
Similar content being viewed by others
References
Fullarton GM, Bell G (1994) Prospective audit of the introduction of laparoscopic cholecystectomy in the West of Scotland. Gut 35:1121–1126
National Institutes of Health (1992) NIH Consensus statement on gallstones and laparoscopic cholecystectomy. Retrieved October 2009 from http://consensus.nih.gov/1992/1992GallstonesLaparoscopy090html
Leggett PL, Bissell CD, Churchman-Winn R, Ahn C (2001) Three-port microlaparoscopic cholecystectomy in 159 patients. Surg Endosc 15:293–296
Huang MT, Wang W, Wei PL, Chen RJ, Lee WJ (2003) Minilaparoscopic and laparoscopic cholecystectomy: a comparative study. Arch Surg 138:1017–1023
Kagaya T (2001) Laparoscopic cholecystectomy via two ports, using the “twin-port” system. J Hepatobiliary Pancreat Surg 8:76–80
Reardon PR, Kamegard JI, Appelbaum B, Rossman L, Brunicardi FC (1999) Feasibility of laparoscopic cholecystectomy with miniaturised instruments in 50 consecutive cases. World J Surg 23:128–131
Poon CM, Chan KW, Lee DW, Chan KC, Ko CW, Cheung HY, Lee KW (2003) Two-port versus four-port laparoscopic cholecystectomy. Surg Endosc 17:1624–1627
Rattner D, Kalloo A (2006) ASGE/SAGES Working Group on natural orifice translumenal endoscopic surgery. Surg Endosc 20:329–333
Chamberlain RS, Sakpal SV (2009) A comprehensive review of single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy. J Gastrointest Surg 13:1733–1740
Pelosi MA, Pelosi MA III (1992) Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med 37:588–594
Hong TH, You YK, Lee KH (2009) Transumbilical single-port laparoscopic cholecystectomy. Surg Endosc 23:1393–1397
Langwieler TE, Nimmesgern T (2009) Single-port access in laparoscopic cholecystectomy. Surg Endosc 23:1138–1141
Lee SK, You YK, Park JH, Kim HJ, Kim DG (2009) Single-port transumbilical laparoscopic cholecystectomy: a preliminary study in 37 patients with gallbladder disease. J Laparoendosc Adv Surg Tech 19:1–5
Romanelli JR, Mark L, Omotosho PA (2008) Single-port laparoscopic cholecystectomy with the TriPort system: a case report. Surg Innov 15:223–228
Saber AA, El-Ghazaly TH (2009) Early experience with single-incision transumbilical laparoscopic adjustable gastric banding using the SILS Port. Int J Surg 7:456–459
Teixeira J, McGill K, Koshy N, McGinty J, Todd G (2010) Laparoscopic single-site surgery for placement of adjustable gastric band: a series of 22 cases. Surg Obes Relat Dis 6:41–45
Zhu JF, Hu H, Ma YZ, Xu MZ, Li F (2009) Transumbilical endoscopic surgery: a preliminary clinical report. Surg Endosc 23:813–817
Tracy CR, Raman JD, Cadeddu JA, Rane A (2008) Laparoendoscopic single-site surgery in urology: where have we been and where are we heading? Nat Clin Pract Urol 5:561–568
Nguyen NT, Hinojosa MW, Smith BR, Reavis KM (2008) Single-laparoscopic-incision transabdominal (SLIT) surgery—adjustable gastric banding: a novel minimally invasive surgical approach. Obes Surg 18:1628–1631
Barbaros U, Dinççağ A (2009) Single-incision laparoscopic splenectomy: the first two cases. J Gastrointest Surg 13:1520–1523
Brunner W, Schirnhofer J, Waldstein-Wartenberg N, Frass R, Weiss H (2009) Single-incision laparoscopic sigmoid colon resections without visible scar: a novel technique. Colorectal Dis 12:66–70
Merchant AM, Lin E (2009) Single-incision laparoscopic right hemicolectomy for a colon mass. Dis Colon Rectum 52:1021–1024
Huang CK, Huong JY, Chiang CJ, Chen YS, Lee PH (2009) Single-incision transumbilical laparoscopic Roux-en-Y gastric bypass: a first case report. Obes Surg 19:1711–1715
de la Torre RA, Satgunam S, Morales MP, Dwyer CL, Scott JS (2009) Transumbilical single-port laparoscopic adjustable gastric band placement with liver suture retractor. Obes Surg 19:1707–1710
Fielding AF, Allen JW (2002) A step-by-step guide to placement of the LAP-BAND adjustable gastric banding system. Am J Surg 184:S26–S30
Singhal R, Kitchen M, Ndirika S, Hunt K, Bridgwater S, Super P (2008) The “Birmingham stitch”: avoiding slippage in laparoscopic gastric banding. Obes Surg 18:359–363
Fletcher DR, Hobbs MS, Tan P, Valinsky LJ, Hockey RL, Pikora TJ, Knuiman MW, Sheiner HJ, Edis A (1999) Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study. Ann Surg 229:449–457
Marks J (2009) SILS port laparoscopic cholecystectomy: postmarket study. http://clinicaltrials.gov/ct2/show/NCT00832767. Accessed October 2009
Ostlie DJ, St Peter SD (2009) Single-incision laparoscopic surgery (SILS) versus laparoscopic cholecystectomy. http://clinicaltrials.gov/ct2/show/NCT00981604. Accessed October 2009
St Peter SD (2009). Single-incision laparoscopic surgery (SILS) versus laparoscopic appendectomy. http://clinicaltrialsfeeds.org/clinical-trials/show/NCT00981136. Accessed October 2009
Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695
Morris-Stiff G Jr, Mitchell S, Barton K, Hassn A (2008) Retraction transaminitis: an inevitable but benign complication of laparoscopic fundoplication. World J Surg 32:2650–2654
Disclosures
Cherry E. Koh, David J. Martin, David J. Cavallucci, Guillermo Becerril-Martinez, and Craig J. Taylor have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Koh, C.E., Martin, D.J., Cavallucci, D.J. et al. On the road to single-site laparoscopic adjustable gastric banding: lessons learned from 60 cases. Surg Endosc 25, 947–953 (2011). https://doi.org/10.1007/s00464-010-1259-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-010-1259-8