Laparoscopic Sleeve Gastrectomy Smart Trocar Site Modification in Patients with Extreme Obesity.

Abstract

Laparoscopic sleeve gastrectomy (LSG) is one of the most common bariatric surgeries performed worldwide. Although it has established itself as a satisfactory procedure on its own, it can also function as the first part of a two-stage treatment strategy. This is especially true in situations of extreme obesity (obesity grade IV or higher). One rationale for choosing a two-stage treatment is the technical difficulty of doing other types of bariatric procedures involving anastomoses due to body physique and level of visceral adiposity. LSG in patients with such a high body mass index (BMI) is comparatively simpler technically, but it does also have a degree of complexity for similar reasons. Here, we present an innovative port configuration for LSG that can significantly reduce ergonomic challenges and enhance the safety of the procedure in patients with extreme obesity. This new trocar site arrangement is generally suitable for individuals with grade IV obesity or above. It is especially effective for people with obesity at or above grade V. Only standard laparoscopic instruments are used. This design preserves the ideal manipulation and elevation angles at 60° and allows surgeons to use standard laparoscopic instruments with lowered shoulders, reducing muscular strain and fatigue. Additionally, it improves patient safety. In patients with extreme obesity, this proposed port configuration for LSG can significantly reduce ergonomic difficulties and increase surgical safety.