Laparoscopic single-port sleeve gastrectomy for morbid obesity: preliminary series

doi:10.1016/j.soard.2010.01.011

Surgery for Obesity and Related Diseases

Volume 6, Issue 6, November–December 2010, Pages 665-669

https://doi.org/10.1016/j.soard.2010.01.011 Get rights and content

Abstract

Background

Laparoscopic sleeve gastrectomy has been recently proposed as a sole bariatric procedure because of the resulting considerable weight loss in morbidly obese patients. Traditionally, laparoscopic sleeve gastrectomy requires 5–6 skin incisions to allow for placement of multiple trocars. With the introduction of single-incision laparoscopic surgery, multiple abdominal procedures have been performed using a sole umbilical incision, with good cosmetic outcomes. The purpose of our study was to evaluate the feasibility and safety of laparoscopic single incision sleeve gastrectomy for morbid obesity.

Methods

A total of 8 consecutive patients underwent laparoscopic single-incision sleeve gastrectomy at the Operative Unit of Bariatric Surgery of the University of Rome Tor Vergata from March 2009 to June 2009.

Results

Of the 8 patients, 5 were women and 3 were men, with a mean age of 44.4 years. The mean preoperative body mass index was 56.2 kg/m². The mean operative time was 128 minutes. The mean postoperative stay was 2.4 days. The mean postoperative body mass index was 49.3 kg/m² at a mean follow-up period of 3.6 months. The mean percentage of excess weight loss was 33% for the same period.

Conclusions

Laparoscopic single-incision sleeve gastrectomy seems to be safe, technically feasible, and reproducible. A randomized trial comparing single-incision sleeve gastrectomy and conventional sleeve gastrectomy might be needed to evaluate the postoperative results in relation to the development of abdominal wall complications.

Section snippets

Methods and Operative Techniques

A total of 8 consecutive patients prospectively underwent laparoscopic single-incision sleeve gastrectomy at the Operative Unit of Bariatric Surgery of the University of Rome Tor Vergata from March 2009 to June 2009. We used the same operative technique and perioperative protocol for all patients. All patients were extensively informed about the technique of single-incision laparoscopic sleeve gastrectomy and gave consent for the procedure. The inclusion criterion was patients with morbid

Results

A total of 8 patients underwent laparoscopic single-incision sleeve gastrectomy at the Operative Unit of Bariatric Surgery of the University of Rome Tor Vergata from March 2009 to June 2009. Of the 8 patients, 5 were women and 3 were men, with a mean age of 44.4 years (range 39–52). The mean preoperative body mass index was 56.2 kg/m² (range 44.2–62.6). The mean operative time was 128 minutes (range 84–140). No conversion to standard laparoscopic surgery was needed. Only 1 postoperative

Discussion

Laparoscopy has great advantages compared with open surgery, and, currently, the interest of most surgeons in even less-invasive surgical techniques, such as natural orifice transluminal endoscopic surgery and SILS, has been increasing. To date, SILS has been applied to several abdominal procedures, including appendectomy, cholecystectomy, splenectomy, and colectomy [4], [5], [6], [7], [8], [10], [11]. The first description of single-incision laparoscopic cholecystectomy was reported in 1999

Conclusions

According to our experience, laparoscopic single-incision sleeve gastrectomy seems to be safe, technically feasible, and reproducible. We have described the technical aspect of the procedure. As long as surgeons are able to safely perform the same procedure using a single incision instead of 5–6 incisions, the overall long-term results should be identical to those with the conventional laparoscopic approach. A randomized trial comparing single-incision sleeve gastrectomy and conventional sleeve

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

References (17)

U. Barbaros et al.
Single incision laparoscopic splenectomy: the first two cases
J Gastrointest Surg
(2009)
J. Teixeira et al.
Laparoscopic single-site surgery for placement of adjustable gastric band—a series of 22 cases
Surg Obes Relat Dis
(2010)
S.C. Oltmann et al.
Single-incision laparoscopic surgery: case report of SILS adjustable gastric banding
Surg Obes Relat Dis
(2009)
Obesity: preventing and managing the global epidemicReport of a WHO consultation
World Health Organ Tech Rep Ser
(2000)
A. Gumbs et al.
Sleeve gastrectomy for morbid obesity
Obes Surg
(2007)
ASMBS position statement on sleeve gastrectomy as a bariatric procedure
R. Tacchino et al.
Single incision laparoscopic cholecystectomy: surgery without a visible scar
Surg Endosc
(2009)
M.A. Cuesta et al.
The “invisible cholecystectomy”: a transumbilical laparoscopic operation without a scar
Surg Endosc
(2008)

There are more references available in the full text version of this article.

Cited by (41)

Bariatric surgical procedures
2018, Presse Medicale
La physiopathologie de l’obésité est complexe et fait intervenir plusieurs facteurs (génétiques, comportementaux, psychologiques…). Dans ce contexte encore peu défini, la chirurgie bariatrique propose des interventions qui modifient l’anatomie du tractus gastro-intestinal, diminuent l’apport calorique, et pour certaines d’entre elles modifient les sécrétions hormonales gastro-intestinales. Le but de ce travail était de décrire les techniques chirurgicales bariatriques actuelles les plus fréquentes (sleeve, anneau gastrique, court-cuit gastrique, diversion biliopancréatique) en précisant leur contexte historique et en envisageant les évolutions possibles.
Obesity physioptahology is complex and involves several factors (genetic, behavioral, psychological…). In this still undefined context, bariatric surgery modifies gastrointestinal tract anatomy, reduces the caloric intake and modifies gastrointestinal hormonal secretions for some of them. Aim of this work was to describe bariatric surgical procedures (sleeve, gastric band, short-gastric gastric, biliopancreatic diversion), specifying their historical context and considering possible evolutions.
Single-port laparoscopic sleeve gastrectomy as a routine procedure in 1000 patients
2016, Surgery for Obesity and Related Diseases
Citation Excerpt :
As observed with the introduction of any novel technique, questions were raised about the safety and the feasibility of the procedure. Since this first study, several teams have reported their experience with single-incision laparoscopic SG [4–12], highlighting bariatric surgeons’ growing enthusiasm for minimally invasive surgery. Our team has gained experience in the field of reduced-port surgery, considering such an approach when judging it compatible with safe accomplishment of the procedure [17–19].
Single-port laparoscopic sleeve gastrectomy (SPSG) is performed routinely in our department as an alternative to a conventional laparoscopic approach.
The aim of this study was to report our surgical results and follow-up outcome after SPSG.
Department of Digestive Minimally Invasive Surgery, Antoine Béclère Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Saclay University, France.
Data from consecutive patients who underwent SPSG in our institution between August 2010 and July 2015 were prospectively collected and retrospectively analyzed. Patients with more than 1-year follow-up were included in our analysis for weight loss and co-morbidity.
A total of 1000 patients underwent SPSG during the study period. Median body mass index was 42.6 kg/m² (range: 33.8–84.6 kg/m²). Median operative time was 112 minutes (range: 50–360 min) and decreased over the years. Completion of the procedure required introduction of an extraport in 78 patients (7.8%). Postoperative mortality and morbidity rates were .1% and 8.1%, respectively. Relaparoscopy and/or endoscopic treatment were required to treat intra-abdominal bleeding in 24 patients (2.4%) and staple-line leakage in 28 patients (2.8%). Five hundred forty-six patients were considered for 1-year follow-up evaluation. Mean excess weight loss was 69% after 1 year and 62.2% after 2 years. Incisional hernia from the trocar site occurred in 20 (3.7%) patients.
Sleeve gastrectomy can be routinely performed using a single-incision laparoscopic technique with equivalent outcomes of surgical morbidity and weight loss compared with conventional laparoscopic surgery. Prospective comparative studies are necessary to assess the potential benefits of this minimally-invasive approach.
Single-port sleeve gastrectomy for super-obese patients
2016, Surgery for Obesity and Related Diseases
Citation Excerpt :
We strongly believe that the natural evolution is from LSG to SPSG [20,21]. We report here the largest series of SPSGs for SOPs in routine bariatric clinical practice, showing the feasibility, reproducibility, efficacy, and, in this series, safety of this surgical procedure [14,15,21]. Median duration of surgery was 89 minutes, similar to classic laparoscopy for SOPs [22].
Laparoscopic sleeve gastrectomy, which has become a primary bariatric procedure in super-obese patients (SOPs), is associated with considerable weight loss. Traditionally, laparoscopic sleeve gastrectomy requires 4–7 skin incisions. Single-port laparoscopic surgery is now feasible for bariatric surgery.
To evaluate the feasibility and safety of single-port sleeve gastrectomy (SPSG) for SOPs.
Department of Abdominal and Minimally Invasive Surgery, Antoine Beclere Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, France.
Evaluation of the outcomes on patients who underwent surgery consecutively from June 2010 to June 2013 with follow-up of>1 year.
In total, 62 patients (46 women, 16 men) underwent SPSG. The median age was 41 years (range 19–67), median preoperative body mass index was 52.2 kg/m² (range 50–87), median operative time was 89 minutes (range 42–212). Twelve patients required additional trocars, and 4.8 % developed complications. The median postoperative stay was 4 days (range 3–9 days) and median follow-up period was 21 months (range 12–48 months) with no loss of follow-up. The median percentage of excess weight loss was 69.7% (range 52%–100%) and percentage of weight loss was 36% (28%–56%) for the same period.
SPSG for SOPs was found to be technically feasible, reproducible, and safe in this series.
Sleeve gastrectomy improves obstructive sleep apnea syndrome (OSAS): 5 year longitudinal study
2016, Surgery for Obesity and Related Diseases
Obstructive sleep apnea syndrome (OSAS) is prevalent among morbidly obese patients. Evaluation of the specific effects of sleeve gastrectomy (SG) on upper airway function has not been reported. Given the possibility that some patients will not respond despite weight loss, no studies have investigated whether other mechanisms may be responsible for persistent OSAS after bariatric surgery.
To evaluate by subjective and objective assessment the impact of SG on upper respiratory physiology in the long-term.
University Hospital, Division of Bariatric and ENT Surgery, in Italy.
Thirty-six consecutive patients with OSAS who underwent laparoscopic SG were prospectively enrolled. The effect of SG on respiratory function and OSAS was followed for 5 years.
All patients completed the 5-year follow-up. A significant (P<.001) improvement in modified Epworth Sleepiness Scale questionnaire (ESS) was obtained in 91.6% (33/36) of patients. The Apnea/Hypopnea index (AHI) improved in 80.6% (29/36) of patients after surgery (from 32.8±1.7 to 5.8±1.2 (P<.001), 4.9±1.7). The remaining 19.4% (7/36) of patients with a positive ESS and/or AHI all had an associated respiratory resistance due to nasal obstructive diseases.
SG improved OSAS overall, but patients who did not improve or only partially improved despite weight loss were found to have an associated nasal responsible pathology. How these patients will respond to nasal surgery and whether a 2-step procedure should be recommended for OSAS patients requires further study.
Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: A systematic review
2014, Surgery for Obesity and Related Diseases
The study compared laparoscopic sleeve gastrectomy (LSG) staple-line leak rates of 4 prevalent surgical options: no reinforcement, oversewing, nonabsorbable bovine pericardial strips (BPS), and absorbable polymer membrane (APM).
LSG is a multipurpose bariatric/metabolic procedure with effectiveness proven through the intermediate term. Staple-line leak is a severe complication of LSG for which no definitive method of prevention has been identified.
The systematic review study design was employed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement screening guidelines. Inclusion criteria centered on variables potentially relevant to LSG leak: leak rate, age, gender, calibrating bougie size, distance between pylorus and gastric transection line, overall complication rate, and mortality. Analysis of variance models were used to explore differences in select demographic and surgical technique variables characterizing each reinforcement group. An omnibus χ² test followed by independent Fisher’s exact tests were used to compare leak rates.
There were 659 articles identified; 41 duplicates removed. Of 618 remaining articles, 324 did not meet inclusion criteria. Of the 294 remaining articles, 206 were eliminated (kin studies, those not reporting staple-line or leak incidence, those reporting discontinued products). There were 88 papers included in the analysis. Statistically significant differences were found between groups across demographic and surgical variables studied (p<0.001). There were 191 leaks in 8,920 patients; overall leak rate 2.1%. Leak rates ranged from 1.09% (APM) to 3.3% (BPS); APM leak rate was significantly lower than other groups (p< 0.05).
Systematic review of 88 included studies representing 8,920 patients found that the leak rate in LSG was significantly lower using APM staple-line reinforcement than oversewing, BPS reinforcement, or no reinforcement.
Routine single-port sleeve gastrectomy: A study of 60 consecutive patients
2013, Surgery for Obesity and Related Diseases
Citation Excerpt :
LESS surgery might have a short learning curve for those with considerable experience in conventional laparoscopy. This is because similar technical challenges, relating to intraperitoneal access, instrument exchange, and coordination with the camera driver are present for both conventional laparoscopy and LESS surgery [12,16,17]. In our experience, the correct positioning of the single port is essential and should be decided according to patient morphology.
Single-port surgery has been developed for many digestive procedures, such as cholecystectomy and colectomy. Our objective was to present our preliminary results for laparoscopic single-port sleeve gastrectomy (SPSG), performed in our department for the treatment of morbid obesity, at Antoine Beclere Hospital and Paris XI University.
From July 2010 to February 2011, all patients evaluated by our multidisciplinary team for morbid obesity and eligible for sleeve gastrectomy underwent SPSG. The data were collected prospectively.
Sixty consecutive patients underwent SPSG. The median age was 40.1 years; 6 patients were men and 48 were white. The median body mass index was 46.5 kg/m². The co-morbidities included diabetes in 12, essential hypertension in 31, sleep apnea in 39, dyslipidemia in 33, and coronary artery disease in 9. Of the 60 patients, 9 had previously undergone laparotomy and 5 had undergone bariatric surgery. The median operating time was 86 minutes. All procedures were achieved laparoscopically, with 10 patients requiring a second trocar and 3 patients 2 additional trocars. No conversion to open surgery was required. One leak was reported, and 1 patient experienced cubital nerve compression. The median hospital stay was 4 days. During a median follow-up of 8 months, most preoperative co-morbidities resolved, and the Bariatric Analysis and Reporting Outcome System score for care efficacy was 6.8 of 9.
SPSG is feasible in routine bariatric surgery. The results for weight loss and co-morbidity resolution seem to be equivalent to those with “multiple port” laparoscopy. New instruments and specific training are required. We believe that this technique is a natural evolution of minimally invasive surgery requiring additional investigation in prospective studies.

View all citing articles on Scopus

View full text

Original articleLaparoscopic single-port sleeve gastrectomy for morbid obesity: preliminary series

Abstract

Background

Methods

Results

Conclusions

Section snippets

Methods and Operative Techniques

Results

Discussion

Conclusions

Disclosures

J Gastrointest Surg

Surg Obes Relat Dis

Surg Obes Relat Dis

Obesity: preventing and managing the global epidemicReport of a WHO consultation

World Health Organ Tech Rep Ser

Sleeve gastrectomy for morbid obesity

Obes Surg

ASMBS position statement on sleeve gastrectomy as a bariatric procedure

Single incision laparoscopic cholecystectomy: surgery without a visible scar

Surg Endosc

The “invisible cholecystectomy”: a transumbilical laparoscopic operation without a scar

Surg Endosc

Original article
Laparoscopic single-port sleeve gastrectomy for morbid obesity: preliminary series