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Simone TARGA

Saint-Pierre University Hospital
Brussels, Belgium
MD
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Advanced bariatric surgery: reduced port simplified gastric bypass, a reproducible 3-port technique
Minimally invasive surgery is a field of continuous evolution and the advantages of this approach is no longer a matter of debate. The laparoscopic Roux-en-Y gastric bypass (LRYGB) has shown to be the cornerstone in the treatment of morbid obesity and so far all the efforts in this technique have been conducted to demonstrate safety and efficacy. Nowadays, reduced port surgery is regaining momentum as the evolution of minimally invasive surgery.
The purpose is to describe our technique of LRYGB, which mimics all the fundamental aspects of the “simplified gastric bypass” described by A. Cardoso Ramos et al. in a conventional laparoscopic surgical approach (5 ports) while incorporating some innovative technical features to reduce the quantity of ports. Despite the use of only three trocars, there is no problem with exposure or ergonomics, which represent major drawbacks when performing reduced port surgery.

Our technique can be a useful and feasible tool in selected patients in order to minimize parietal trauma and its possible complications, to improve cosmetic results, and to indirectly avoid the need for a second assistant, thereby improving the logistics, team dynamics, and economic aspects of the procedure.

In our experience, this technique is indicated as primary surgery in patients without previous surgery and with a BMI ranging from 35 to 50. Major contraindications are liver steatosis, superobese patients, and potentially revisional surgery. Although based on the experience of the team, we had also to perform revisional surgery mostly from ring vertical gastroplasty.

From January 2015 to June 2017, we analyzed 72 consecutive cases in our institution with a mean initial BMI of 43.12 (range: 30.1-58.7) using this approach, and the mean operative time was 64.77 minutes (range: 30-155, n=72) and excluding revisional cases or cases associated with cholecystectomy (58.72 min, range: 30-104, n=62).

This approach should be performed by highly skilled surgeons experienced with conventional Roux-en-Y gastric bypass and with one of the patients feeling particularly comfortable. We strongly suggest using additional trocars if patient safety is jeopardized.
D Lipski, D Garcilazo Arismendi, S Targa
Surgical intervention
1 year ago
2704 views
424 likes
1 comment
07:37
Advanced bariatric surgery: reduced port simplified gastric bypass, a reproducible 3-port technique
Minimally invasive surgery is a field of continuous evolution and the advantages of this approach is no longer a matter of debate. The laparoscopic Roux-en-Y gastric bypass (LRYGB) has shown to be the cornerstone in the treatment of morbid obesity and so far all the efforts in this technique have been conducted to demonstrate safety and efficacy. Nowadays, reduced port surgery is regaining momentum as the evolution of minimally invasive surgery.
The purpose is to describe our technique of LRYGB, which mimics all the fundamental aspects of the “simplified gastric bypass” described by A. Cardoso Ramos et al. in a conventional laparoscopic surgical approach (5 ports) while incorporating some innovative technical features to reduce the quantity of ports. Despite the use of only three trocars, there is no problem with exposure or ergonomics, which represent major drawbacks when performing reduced port surgery.

Our technique can be a useful and feasible tool in selected patients in order to minimize parietal trauma and its possible complications, to improve cosmetic results, and to indirectly avoid the need for a second assistant, thereby improving the logistics, team dynamics, and economic aspects of the procedure.

In our experience, this technique is indicated as primary surgery in patients without previous surgery and with a BMI ranging from 35 to 50. Major contraindications are liver steatosis, superobese patients, and potentially revisional surgery. Although based on the experience of the team, we had also to perform revisional surgery mostly from ring vertical gastroplasty.

From January 2015 to June 2017, we analyzed 72 consecutive cases in our institution with a mean initial BMI of 43.12 (range: 30.1-58.7) using this approach, and the mean operative time was 64.77 minutes (range: 30-155, n=72) and excluding revisional cases or cases associated with cholecystectomy (58.72 min, range: 30-104, n=62).

This approach should be performed by highly skilled surgeons experienced with conventional Roux-en-Y gastric bypass and with one of the patients feeling particularly comfortable. We strongly suggest using additional trocars if patient safety is jeopardized.
Reduced port laparoscopic pyloroduodenectomy with handsewn Roux-en-Y reconstruction
Background: Reduced port laparoscopic surgery (RPLS) is an evolution of conventional laparoscopic surgery, allowing for enhanced cosmetic outcomes, in addition to a reduced abdominal wall trauma. Tips and tricks are required to complete a procedure using a RPLS.

Video: This video shows a 55-year-old lady who underwent a laparoscopic pyloro-duodenectomy for a duodenal bulb lesion increased in size at endoscopic follow-up. Three trocars were used (a 12mm one in the umbilicus, a 5mm one in the right flank, a 5mm one in the left flank). The exposure of the operative field was enhanced thanks to a temporary percutaneous suture placed into the hepatic round ligament. Perioperative gastroscopy allowed for an adequate resection without too much distance from the margins, and preservation of the entire gastric antrum. The reconstruction was performed through a handsewn end-to-end gastrojejunostomy, with a 50cm alimentary limb, and a semi-mechanical side-to-side jejunojejunostomy. Finally, a gastroscopy was used to test the gastrojejunostomy.

Results: Total operative time was 190 minutes. Perioperative bleeding was 50cc. Postoperative course was uneventful, and the patient was discharged on postoperative day 7. Pathological findings demonstrated a Brunner’s gland hamartoma, with safe distance from the margins.

Conclusions: RPLS is a step forward of conventional laparoscopy. Perioperative gastroscopy is essential to perform safe upper GI resections. br>
G Dapri, NA Bascombe, S Targa
Surgical intervention
1 year ago
774 views
25 likes
0 comments
09:01
Reduced port laparoscopic pyloroduodenectomy with handsewn Roux-en-Y reconstruction
Background: Reduced port laparoscopic surgery (RPLS) is an evolution of conventional laparoscopic surgery, allowing for enhanced cosmetic outcomes, in addition to a reduced abdominal wall trauma. Tips and tricks are required to complete a procedure using a RPLS.

Video: This video shows a 55-year-old lady who underwent a laparoscopic pyloro-duodenectomy for a duodenal bulb lesion increased in size at endoscopic follow-up. Three trocars were used (a 12mm one in the umbilicus, a 5mm one in the right flank, a 5mm one in the left flank). The exposure of the operative field was enhanced thanks to a temporary percutaneous suture placed into the hepatic round ligament. Perioperative gastroscopy allowed for an adequate resection without too much distance from the margins, and preservation of the entire gastric antrum. The reconstruction was performed through a handsewn end-to-end gastrojejunostomy, with a 50cm alimentary limb, and a semi-mechanical side-to-side jejunojejunostomy. Finally, a gastroscopy was used to test the gastrojejunostomy.

Results: Total operative time was 190 minutes. Perioperative bleeding was 50cc. Postoperative course was uneventful, and the patient was discharged on postoperative day 7. Pathological findings demonstrated a Brunner’s gland hamartoma, with safe distance from the margins.

Conclusions: RPLS is a step forward of conventional laparoscopy. Perioperative gastroscopy is essential to perform safe upper GI resections. br>