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Preliminary surgical results of single-incision transumbilical laparoscopic bariatric surgery.

Huang CK, Tsai JC, Lo CH, Houng JY, Chen YS, Chi SC, Lee PH - Obes Surg (2010)

Bottom Line: We then assessed the safety and effectiveness of our surgical technique.Most patients were very satisfied with the cosmetic outcomes.Our technique can be safely and effectively used for SITU laparoscopic bariatric surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, E-Da Hospital, 1 E-Da Road, Jiau-shu Tseun, Yan-chau Shiang, Kaohsiung County, 824, Taiwan. dr.ckhuang@hotmail.com

ABSTRACT

Background: Recently, single-incision laparoscopic surgery (SILS) has been used for bariatric procedures, and this surgery is considered a type of minimally invasive surgery. When SILS is performed via the transumbilical route, the resultant abdominal wound is hidden and the cosmetic outcome is better. However, because of the small angle of manipulation and difficulty in liver traction, this technique is not used to perform complex bariatric surgery. In this prospective study, we used our novel technique, which involves the use of a liver-suspension tape and umbilicoplasty of an omega-shaped incision (omega umbilicoplasty), to perform laparoscopic bariatric surgery via the single-incision transumbilical (SITU) approach. We then assessed the safety and effectiveness of our surgical technique.

Methods: We started performing and developing this technique from December 2008. Until July 2009, 40 consecutive patients underwent 40 bariatric procedures: two adjustable gastric band placements, six sleeve gastrectomies, and 32 Roux-en-Y gastric bypass operations, including five cases where concomitant cholecystectomy was performed.

Results: The mean operation time was 93.4 min and the mean duration of postoperative hospitalization was 1.15 days. No perioperative or postoperative complications or deaths occurred. Most patients were very satisfied with the cosmetic outcomes.

Conclusion: Our technique can be safely and effectively used for SITU laparoscopic bariatric surgery. This technique will soon be used for advanced abdominal surgeries besides bariatric ones.

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Related in: MedlinePlus

Umbilicoplasty procedure: a repair the fascial defect, b umbilicoplasty, c circular wound repair. d Cosmetic outcome of the umbilical wound 3 months after the surgery
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Related In: Results  -  Collection


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Fig3: Umbilicoplasty procedure: a repair the fascial defect, b umbilicoplasty, c circular wound repair. d Cosmetic outcome of the umbilical wound 3 months after the surgery

Mentions: The patient was placed in the supine position with the arms extended laterally. An anesthesiologist induced general anesthesia and performed endotracheal intubation. For most operations, the surgeon stood on the right side of the patient and the assistant on the left. A 6-cm-long omega-shaped incision was made around the upper half of the umbilicus (Fig. 1a). The incision was deepened to the linea alba after dissecting the subcutaneous fat, and a 12- or 15-mm Versaport plus V2 trocar (Covidien) was inserted into the arch of the omega-shaped incision after establishing pneumoperitoneum, produced by carbon dioxide insufflation at a pressure of 15 mmHg. A 10-mm-long, rigid, 30° video laparoscope was then inserted. Under direct visualization, two Versaport plus V2 trocars (sizes, 5 and 11 mm) with fixation cannulas (Covidien) were inserted through both arms of the omega incision (Fig. 1b). We then inserted the LST into the peritoneal cavity. To prepare the LST, the length of the liver lobe was measured intraoperatively and a Jackson–Pratt drain tube was cut to the same length near the site of the drainage hole. Subsequently, 2-0 prolene sutures (monofilament polypropylene suture W8400; Ethicon) were inserted along the holes of the drain tube and the two needles attached to the sutures were retained for liver puncture (Fig. 2). One needle was placed in a needle holder, inserted into the lateral edge of the left liver lobe, and brought out through the abdominal wall in the left upper quadrant; the other needle was inserted into the left liver lobe near the falciform ligament and then brought out through the abdominal wall in the right upper quadrant. The liver was then retracted to an appropriate position, and the sutures were suspended with clamps (Fig. 2). If one LST was not sufficient to suitably retract the liver, we used another LST. During the cholecystectomies, the right liver lobe was similarly retracted with the LST if the Calot triangle was difficult to visualize and if dissection without countertraction was tedious. The tape was inserted into the edge of the right liver lobe, and the liver was retracted upward and in the cephalic direction. After achieving the appropriate liver traction, we commenced the surgical procedure. For SITU-laparoscopic Roux-en-Y gastric bypass (LRYGB), we used laparoscopic linear staplers (Endo GIA™ Universal Staplers XL, Covidien) to divide the stomach and form a 25-cc gastric pouch and 2.5-cm-long gastrojejunostomy. Next, jejunojejunostomy was also performed with linear staplers. The gastrojejunostoma was closed by a hand-sewn technique, using the Endo Stitch™ suturing device. An adjustable gastric band (Ethicon) was used for the SITU-LAGBP procedure, performed with the pars flaccida method. A gastrogastric suture was performed using 2-0 Ethibond (Ethicon). After completing the procedure, the catheter was extracted from the 15-mm port, connected to the injection port, and fixed in the paraumbilical area. In the SITU-LSG procedure, devascularization of the greater curvature was started 5 cm away from the pylorus and continued till the angle of Hiss, using the AutoSonix™ Ultra Shears™ Long Instrument (Covidien). The Fr36 calibration tube was retained as a stent for vertical gastrectomy using Endo GIA. After the completion of the main operative procedure, the LST was removed and hemostasis was achieved by cauterization. All trocars were removed and the surgical specimens were extracted into a plastic bag via the 12- or 15-mm umbilical defect through which the trocars had been inserted. All the fascial defects were closed individually with 2-0 Vicryl sutures. Subsequently, an omega umbilicoplasty was performed such that the resultant wound was circular and hidden in the umbilicus (Fig. 3a–c). The surgical wound was dressed. The patients were transferred to the postoperative recovery room and then to the ward, provided their immediate postoperative course was uneventful. The patients were permitted to drink water and were discharged early if they did not develop any complications.Fig. 1


Preliminary surgical results of single-incision transumbilical laparoscopic bariatric surgery.

Huang CK, Tsai JC, Lo CH, Houng JY, Chen YS, Chi SC, Lee PH - Obes Surg (2010)

Umbilicoplasty procedure: a repair the fascial defect, b umbilicoplasty, c circular wound repair. d Cosmetic outcome of the umbilical wound 3 months after the surgery
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3040807&req=5

Fig3: Umbilicoplasty procedure: a repair the fascial defect, b umbilicoplasty, c circular wound repair. d Cosmetic outcome of the umbilical wound 3 months after the surgery
Mentions: The patient was placed in the supine position with the arms extended laterally. An anesthesiologist induced general anesthesia and performed endotracheal intubation. For most operations, the surgeon stood on the right side of the patient and the assistant on the left. A 6-cm-long omega-shaped incision was made around the upper half of the umbilicus (Fig. 1a). The incision was deepened to the linea alba after dissecting the subcutaneous fat, and a 12- or 15-mm Versaport plus V2 trocar (Covidien) was inserted into the arch of the omega-shaped incision after establishing pneumoperitoneum, produced by carbon dioxide insufflation at a pressure of 15 mmHg. A 10-mm-long, rigid, 30° video laparoscope was then inserted. Under direct visualization, two Versaport plus V2 trocars (sizes, 5 and 11 mm) with fixation cannulas (Covidien) were inserted through both arms of the omega incision (Fig. 1b). We then inserted the LST into the peritoneal cavity. To prepare the LST, the length of the liver lobe was measured intraoperatively and a Jackson–Pratt drain tube was cut to the same length near the site of the drainage hole. Subsequently, 2-0 prolene sutures (monofilament polypropylene suture W8400; Ethicon) were inserted along the holes of the drain tube and the two needles attached to the sutures were retained for liver puncture (Fig. 2). One needle was placed in a needle holder, inserted into the lateral edge of the left liver lobe, and brought out through the abdominal wall in the left upper quadrant; the other needle was inserted into the left liver lobe near the falciform ligament and then brought out through the abdominal wall in the right upper quadrant. The liver was then retracted to an appropriate position, and the sutures were suspended with clamps (Fig. 2). If one LST was not sufficient to suitably retract the liver, we used another LST. During the cholecystectomies, the right liver lobe was similarly retracted with the LST if the Calot triangle was difficult to visualize and if dissection without countertraction was tedious. The tape was inserted into the edge of the right liver lobe, and the liver was retracted upward and in the cephalic direction. After achieving the appropriate liver traction, we commenced the surgical procedure. For SITU-laparoscopic Roux-en-Y gastric bypass (LRYGB), we used laparoscopic linear staplers (Endo GIA™ Universal Staplers XL, Covidien) to divide the stomach and form a 25-cc gastric pouch and 2.5-cm-long gastrojejunostomy. Next, jejunojejunostomy was also performed with linear staplers. The gastrojejunostoma was closed by a hand-sewn technique, using the Endo Stitch™ suturing device. An adjustable gastric band (Ethicon) was used for the SITU-LAGBP procedure, performed with the pars flaccida method. A gastrogastric suture was performed using 2-0 Ethibond (Ethicon). After completing the procedure, the catheter was extracted from the 15-mm port, connected to the injection port, and fixed in the paraumbilical area. In the SITU-LSG procedure, devascularization of the greater curvature was started 5 cm away from the pylorus and continued till the angle of Hiss, using the AutoSonix™ Ultra Shears™ Long Instrument (Covidien). The Fr36 calibration tube was retained as a stent for vertical gastrectomy using Endo GIA. After the completion of the main operative procedure, the LST was removed and hemostasis was achieved by cauterization. All trocars were removed and the surgical specimens were extracted into a plastic bag via the 12- or 15-mm umbilical defect through which the trocars had been inserted. All the fascial defects were closed individually with 2-0 Vicryl sutures. Subsequently, an omega umbilicoplasty was performed such that the resultant wound was circular and hidden in the umbilicus (Fig. 3a–c). The surgical wound was dressed. The patients were transferred to the postoperative recovery room and then to the ward, provided their immediate postoperative course was uneventful. The patients were permitted to drink water and were discharged early if they did not develop any complications.Fig. 1

Bottom Line: We then assessed the safety and effectiveness of our surgical technique.Most patients were very satisfied with the cosmetic outcomes.Our technique can be safely and effectively used for SITU laparoscopic bariatric surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, E-Da Hospital, 1 E-Da Road, Jiau-shu Tseun, Yan-chau Shiang, Kaohsiung County, 824, Taiwan. dr.ckhuang@hotmail.com

ABSTRACT

Background: Recently, single-incision laparoscopic surgery (SILS) has been used for bariatric procedures, and this surgery is considered a type of minimally invasive surgery. When SILS is performed via the transumbilical route, the resultant abdominal wound is hidden and the cosmetic outcome is better. However, because of the small angle of manipulation and difficulty in liver traction, this technique is not used to perform complex bariatric surgery. In this prospective study, we used our novel technique, which involves the use of a liver-suspension tape and umbilicoplasty of an omega-shaped incision (omega umbilicoplasty), to perform laparoscopic bariatric surgery via the single-incision transumbilical (SITU) approach. We then assessed the safety and effectiveness of our surgical technique.

Methods: We started performing and developing this technique from December 2008. Until July 2009, 40 consecutive patients underwent 40 bariatric procedures: two adjustable gastric band placements, six sleeve gastrectomies, and 32 Roux-en-Y gastric bypass operations, including five cases where concomitant cholecystectomy was performed.

Results: The mean operation time was 93.4 min and the mean duration of postoperative hospitalization was 1.15 days. No perioperative or postoperative complications or deaths occurred. Most patients were very satisfied with the cosmetic outcomes.

Conclusion: Our technique can be safely and effectively used for SITU laparoscopic bariatric surgery. This technique will soon be used for advanced abdominal surgeries besides bariatric ones.

Show MeSH
Related in: MedlinePlus