Transumbilical single access laparoscopic sleeve gastrectomy plus 1.8mm trocarless grasping forceps
Epublication WebSurg.com, Jan 2016;16(01). URL: http://websurg.com/doi/vd01en4494
Background: Transumbilical single access laparoscopy (TSAL) has gained interest over the last decade. However, in bariatric surgery, it still remains difficult due to the fact that the umbilicus is not a landmark, and it is frequently localized too far from the operative field. In selected patients, it can be considered and offered. Video: A 29-year-old morbidly obese woman with a BMI of 40 underwent TSAL sleeve gastrectomy. Two reusable ports and curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany) were placed in the umbilicus. The chosen method to perform sleeve gastrectomy was a medial-to-lateral approach (gastric division followed by greater curvature mobilization), and the resection of the gastric antrum. Gastric division was performed under the control of a long, rigid, 30-degree scope (Karl Storz). To expose the hiatal region and the angle of His, a 1.8mm trocarless grasping forceps according to DAPRI (Karl Storz) was inserted underneath the xiphoid process and placed against the diaphragm below the left liver lobe. Some absorbable sutures between the staple lines were finally placed, and no drain was left into the abdominal cavity. The specimen was removed transumbilically, after joining the three used windows together at the umbilical aponeurosis. Results: Laparoscopy took 94 minutes and perioperative bleeding was 30cc. Umbilical scar length was 25mm. No postoperative complications were noted and the patient was discharged on postoperative day 4. Conclusions: TSAL sleeve gastrectomy can be offered to selected obese patients. The use of reusable material and curved tools make it possible not to increase the cost of the procedure due to TSAL, and to establish intracorporeal and extracorporeal working triangulation.