Single-incision sleeve gastrectomy using a novel technique for liver retraction

Abstract

Introduction: Laparoscopic sleeve gastrectomy has rapidly gained popularity in the field of bariatric surgery, mainly due to its low morbidity and mortality. Traditionally, 4 to 6 trocars are used. Single-access surgery has emerged as an attempt to decrease incisional morbidity and enhance cosmetic benefits. We present our initial 7 patients undergoing single-incision laparoscopic sleeve gastrectomy using a novel technique for liver retraction.

Methods: Patients who underwent single-incision laparoscopic sleeve gastrectomy between March 2009 and May 2009 were analyzed. A 4-cm left paramedian incision was used. Laparoscopic sleeve gastrectomy was performed in a standard fashion using a 40 French bougie.

Results: Seven patients underwent single-incision sleeve gastrectomy at the University of Illinois at Chicago. They were all female with a mean age of 34 years. Preoperative BMI was 49 kg/m² (range, 39 to 64). There were no intraoperative complications. Mean operative time was 103 minutes. Estimated blood loss was minimal. All 7 patients were discharged on postoperative day 2 and were doing well without any complications at 3.1 ± 0.7 months after surgery.

Conclusion: Single-incision laparoscopic sleeve gastrectomy is safe and feasible and can be performed without changing the existing principles of the procedure. Our technique for internal liver retraction provides adequate exposure and is reproducible. Development of improved standard instrumentation is required for this technique to become popular.

Figure 1.

Internal retractor developed by securing a Lone Star retractor hook (Lone Star Medical Products, Stafford, TX) to a laparoscopic bulldog clamp (Aesculap, Tuttlingen, Germany).

Figure 2.

A 4-cm incision is made superior and left of the umbilicus.

Figure 3.

Left lobe of the liver before and after placement of the internal liver retractor. The bulldog is introduced into the abdomen and attached to the pars flaccida, while the hook is secured to the parietal peritoneum or the falciform ligament as needed.