Preliminary surgical results of single-incision transumbilical laparoscopic bariatric surgery

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.

Fig. 1

A horizontal 6-cm-long omega-shaped skin incision around the upper half of the umbilicus (a); triangular positioning of and distance between trocars (b)

Fig. 2

Design for the application of the LST used for liver retraction. We measured the length of the left liver lobe intraoperatively and then cut a Jackson–Pratt drain tube to the same length near the site of the drainage hole. We penetrated it with a 2-0 prolene suture (monofilament polypropylene suture W8400; Ethicon). The needles were retained at both sides for further liver puncture. The liver-retraction procedure: a One of the needles attached to the LST was inserted into the left edge of the liver and then brought out through the abdominal wall in the left upper quadrant. b The other needle attached to the tape was inserted into the left liver lobe near the falciform ligament and then brought out through the abdominal wall in the midline. The liver was retracted to an appropriate position and the sutures fixed with Kelly clamps. c The right liver lobe suspended for retraction

Fig. 3

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