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Single Incision Bariatric Surgery

Single Incision Bariatric Surgery. Ninh T. Nguyen, MD, FACS University of California, Irvine Medical Center, Orange, CA. Disclosures. Covidien Grant/speaker Gore Speaker Surgiquest Consultant Reshape Research Ethicon Speaker. Rationale for Single Incision Bariatric.

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Single Incision Bariatric Surgery

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  1. Single Incision Bariatric Surgery Ninh T. Nguyen, MD, FACS University of California, Irvine Medical Center, Orange, CA

  2. Disclosures • Covidien Grant/speaker • Gore Speaker • Surgiquest Consultant • Reshape Research • Ethicon Speaker

  3. 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

  4. 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)

  5. 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)

  6. Evolution of Single IncisionSleeve Gastrectomy“Happy Medium” SILS LESS SILS Hybrid SLIC

  7. Balanced Strategy to Single Incision Bariatric Surgery • - Technical difficulty • Compromising safety • Prolong OR time Improved cosmesis

  8. Conventional vs SLIC Sleeve

  9. Hurdles from Laparoscopy to SILS • Lack triangulation • Use of 5 mm scope • “Fighting” of instrumentation

  10. Evolution of SILS to SLIC • Better triangulation • Less “fighting” of instrumentation

  11. NOTUS Cholecystectomy

  12. NOTUS Appendectomy NOTUS Cecectomy.mpg

  13. SLIC Gastric Banding

  14. Laparoscopic vs. Single Incision Gastric Band →

  15. Single Incision Gastric Band Lap Band SLIT band realize.mpg

  16. 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

  17. Trocar Position for SLIC Gastric Banding Lap band SLIT realize fast.wmv

  18. Laparoscopic vs. SLIC Gastric Banding Characteristics *p<0.05, two-sample t tests

  19. Laparoscopic vs. SLIC Gastric Banding Outcomes

  20. SLIC Gastric Banding

  21. SLIC Sleeve Gastrectomy

  22. Evolution of Single IncisionSleeve Gastrectomy“Happy Medium” SILS LESS SILS Hybrid SLIC

  23. Evolution of SLIC Sleeve Gastrectomy X

  24. SLIC Sleeve

  25. Laparoscopic vs. SILS Sleeve Characteristics *p<0.05, two-sample t tests

  26. Laparoscopic vs. SILS Sleeve

  27. Relative Contraindications of SLIC • BMI > 50 • Need to perform other procedures (hiatal hernia repair) • Hx of prior bariatric or gastric surgery

  28. SLIC Sleeve Gastrectomy

  29. SLIC Sleeve Gastrectomy

  30. 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

  31. Single Incision Bariatric Surgery Ninh T. Nguyen, MD, FACS University of California, Irvine Medical Center, Orange, CA

  32. Strategic Laparoscopy for Improved Cosmesis (SLIC) – Bariatric Surgery Ninh T. Nguyen, MD, FACS University of California, Irvine Medical Center, Orange, CA

  33. We’re Making Progress Come on! It can‘t go wrong every time...

  34. Philosophy of SLIC • Transition most or all laparoscopic trocars to strategic location that minimize operative scar- Umbilicus- Suprapubic region • One visible 5 mm incision

  35. SLIC Cholecystectomy

  36. Spectrum of Invasiveness Open Laparoscopic Single Incision

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