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Single Incision Bariatric Surgery
Ninh T. Nguyen, MD, FACS
University of California, Irvine University of California, Irvine
Medical Center, Orange, CAMedical Center, Orange, CA
Disclosures
• Covidien Grant/speaker• Gore Speaker• Surgiquest Consultant• Reshape Research• Ethicon Speaker
Rationale for Single Incision Bariatric
• Band – need a 3.5 cm incision to place subQ port
• Sleeve – need to remove gastric specimen
• Bypass – no role
Acronym
• Single Port Access (SPA)
• Natural Orifice Transumbilical Surgery (NOTUS)
• Single Incision Laparoscopic Surgery (SILS)
• Single Laparoscopic Incision Transabdominal (SLIT) surgery
• Laparosendoscopic Single Site Surgery (LESS)
• Strategic Laparoscopy for Improved Cosmesis (SLIC)
Philosophy of SLIC
• Strategic use of anatomic sites that will minimize visible postoperative scars - Umbilicus- Suprapubic region
• Not new philosophy (plastic, ENT, GYN)
• Still laparoscopy (maintain triangulation)
Evolution of Single IncisionSleeve Gastrectomy
“Happy Medium”
SILS LESS SLICSILS Hybrid
Balanced Strategy to Single Incision Bariatric Surgery
Improved cosmesis
- Technical difficulty -Compromising safety-Prolong OR time
Conventional vs SLIC Sleeve
Hurdles from Laparoscopy to SILS
• Lack triangulation
• Use of 5 mm scope
• “Fighting” of instrumentation
Evolution of SILS to SLIC• Better triangulation
• Less “fighting” of instrumentation
NOTUS Cholecystectomy
NOTUS AppendectomyNOTUS Cecectomy.mpg
SLIC Gastric Banding
Laparoscopic vs. Single Incision Gastric Band
→
Single Incision Gastric BandLap Band SLIT band realize.mpg
Evolution of Single Incision Gastric Banding
• Single incision (4-4.5 cm) between umbilicus and xyphoid process
• Transition to single incision (3.2 cm) and three 5 mm trocars within umbilicus
Trocar Position for SLIC Gastric Banding
Lap band SLIT realize fast.wmv
Laparoscopic vs. SLIC Gastric Banding
Characteristics
Characteristics Laparoscopy(n=23)
SLIC(n=23)
Female : Male 17 : 6 17 : 6
Age (years) 50 ±9 47 ±10
Preop weight (lbs) 252 ±39 248 ±32
Mean BMI (kg/m2) 40 ±4 (range, 35-49) 39 ±4 (range, 35-48)
*p<0.05, two-sample t tests
Laparoscopic vs. SLIC Gastric Banding
Outcomes
Outcomes Laparoscopy(n=23)
SLIC(n=23)
Conversion to Laparoscopy (%) 0 13
OR time (min) 66 ±21 65 ±20
Blood loss (ml) 22 ±21 14 ±5
Hospital stay (days) 1.4 ±0.9 1.1 ±0.5
Early Complications (%) 0 0
Late Complications (%) 0 0
SLIC Gastric Banding
21 |
SLIC Sleeve Gastrectomy
Evolution of Single IncisionSleeve Gastrectomy
“Happy Medium”
SILS LESS SLICSILS Hybrid
Evolution of SLIC Sleeve Gastrectomy
X
SLIC Sleeve
Laparoscopic vs. SILS Sleeve
Characteristics
Characteristics Laparoscopy(n=24)
SLIC(n=26)
Female : Male 16 : 8 17 : 9
Age (years) 47 ± 11 44 ± 11
Mean BMI (kg/m2) 47 ± 7* 42 ± 4
*p<0.05, two-sample t tests
Laparoscopic vs. SILS Sleeve
Outcomes Laparoscopy(n=24)
SLIC(n=26)
Conversion to Laparoscopy (%) --- 3.8%
OR time (min) 78 ±26 84 ±24
Blood loss (ml) 23 ± 14 30 ± 21
Mean hospital stay (days) 1.4 ± 0.6 1.8 ±0.7
Intraoperative complications (%) 0% 7.7%
Major Complications (%) 0% 0%
Minor Complications (%) 8.3% 7.7%
Relative Contraindications of SLIC
• BMI > 50
• Need to perform other procedures (hiatal hernia repair)
• Hx of prior bariatric or gastric surgery
SLIC Sleeve Gastrectomy
SLIC Sleeve Gastrectomy
Conclusions• In a selected group of patient, SLIC bariatric operations are feasible
• Safe – no major complications
• Reproducible – low conversion rate to laparoscopy
• Outcomes - comparable between SLIC vs. laparoscopic sleeve & band without prolonging the operative time
• Cost – comparable with utilization of mostly conventional trocars, instrument, and scope
Single Incision Bariatric Surgery
Ninh T. Nguyen, MD, FACS
University of California, Irvine University of California, Irvine
Medical Center, Orange, CAMedical Center, Orange, CA
Strategic Laparoscopy for Improved Cosmesis (SLIC) – Bariatric Surgery
Ninh T. Nguyen, MD, FACS
University of California, Irvine University of California, Irvine
Medical Center, Orange, CAMedical Center, Orange, CA
We’re Making Progress
Come on! It can‘t go
wrong every time...
Philosophy of SLIC
• Transition most or all laparoscopic trocars to strategic location that minimize operative scar- Umbilicus- Suprapubic region
• One visible 5 mm incision
SLIC Cholecystectomy
Spectrum of Invasiveness
Open Laparoscopic Single Incision
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