Single-port Sleeve Gastrectomy Research Articles

Routine gastric suspension technique in single-port sleeve gastrectomy procedure.

Due to limited technical demand, single-port sleeve gastrectomy (SPSG) is a feasible laparoscopic technique for sleeve gastrectomy (SG). Nonetheless, difficulties exist when performing the single-port technique, and in this study, we aim to describe a slight maneuver that can improve the SPSG procedure. Patients who underwent laparoscopic SG between January 2022 and May 2023 at our hospital were included. The patients were classified into two groups: (1) SPSG and (2) multiple-port SG (MPSG). The parameters for this analysis were the patients' age, gender, weight, body mass index (BMI), conversion rate, drainage placement, 30-day readmission rate, and postoperative complications. Postoperative one-month and three-month percentages of total weight loss (%TWL) were calculated and compared. 171 patients were included in this study: (1) the SPSG group (n = 96) and (2) the MPSG group (n = 75). No statistically significant difference was observed within the preoperative (age, gender, height, weight, and BMI) and the perioperative parameters between SPSG and MPSG (operation time, drainage placement, 30-day readmission) (p > 0.05). Per Clavien-Dindo's grading, two patients in the SPSG group suffered grade 1 complications; for the MPSG group, one patient sustained grade 2 and another suffered grade 3b complication. No statistical significance was observed on the %TWL between the two groups (p > 0.05). Our study found that performing SPSG in specific patient is feasible and non-inferior when compared to the MPSG. Further studies will be needed to elucidate better the efficacy and safety of performing SPSG.

Magnetic device in reduced port and single port bariatric surgery: First 170 cases experience

IntroductionMagnetic devices have been successfully used in bariatric surgery. To the date, the only reported use of the magnet was for liver retraction. Our purpose in this study is to demonstrate the safety and viability of using a magnetic system in different steps in single port and reduced port bariatric surgery. MethodsProspective and observational study was performed. Patients older than 18 years, undergoing primary laparoscopic sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and Roux-en-Y gastric bypass (RYGB) or revisional surgery by single-port or reduced-port approach between July 2020 and June 2021 were included. ResultsA total of 170 patients (mean BMI, 41.47kg/m2; mean age 36.92 yrs) completed laparoscopic bariatric surgery (54 single-port sleeve gastrectomy [SPSG], 16 reduced-port SG, 83 RYGB, 4 OAGB and 14 revision surgeries), using the magnetic surgical system in different steps of the surgery. Mean surgical time for SPSG and reduced-port SG was 65.52min and 59.36min respectively; and for RYGB 74.19min, OAGB 70.98min, and revisional surgeries 88.38min. As for intraoperative complications, 2.94% mild liver laceration without significant bleeding was reported. There were no 30-day mortalities and no major complications. ConclusionMagnetic assistance in single-port and reduced-port bariatric surgery is an innovative technique. With this prospective study we attempt to demonstrate the safety profile and potential uses that may improve the implementation of new surgical approaches in bariatric surgery.

Immediate postoperative pain does not predict pain at home after ambulatory single-port sleeve gastrectomy.

Single-port sleeve gastrectomy (SPSG) is increasingly performed in an ambulatory setting. Pain intensity when returning home remains a problem. The challenge is to be able to predict the evolution of postoperative pain (POP) at home by using parameters collected during the hospital stay. This study aimed to investigate whether immediate POP in the postanesthesia care unit (PACU) can predict pain intensity 24h after surgery. Single-center retrospective study in patients with obesity who underwent ambulatory SPSG. POP and opiate requirements during PACU stay were registered. Patients were followed up at home during the first 4 postoperative days. The primary outcome was the correlation between opiate requirements in the PACU and Numerical Rating Scale (NRS) at home 24h after surgery. Secondly, logistic regression was used to identify risk factors for moderate/intense pain 24h after surgery. Ninety-four patients were included during the study period. Twenty-two patients had NRS > 3/10 24h after surgery. No correlation was found between the total dose of morphine in the PACU and pain intensity 24h after surgery (r2 = - 0.07; P = 0.49). No predictive factor for moderate/intense pain 24h after surgery was found. No correlation was found between opiate requirements in the PACU and pain at home 24h after SPSG. Based on these results, it does not seem possible to predict intense pain at home from pain profile and morphine requirement during the immediate postoperative period.

Comparison of HIV-Infected and Noninfected Patients Undergoing Bariatric Surgery: The ObeVIH Study.

The aim of this study was to compare clinical characteristics and adipose/liver tissue histology analysis in HIV-infected and HIV-uninfected subjects undergoing bariatric surgery. This was a cross-sectional study of HIV-infected subjects undergoing single-port sleeve gastrectomy with prospective enrolment and frequency age (±5 years), sex, and body mass index (BMI, ± 5 kg/m2) matched on HIV-uninfected subjects. This study was conducted at a single clinical site at Pitié-Salpêtrière hospital-Paris-France comprising 19 HIV-uninfected and 21 HIV-infected subjects with plasma VL < 20 copies/mL, all with a BMI > 40 kg/m2 or >35 kg/m2 with comorbidities. Histology of subcutaneous and visceral abdominal adipose tissue (SCAT/VAT) and liver biopsies was collected during single-port sleeve gastrectomy. Outcomes included anthropometric characteristics, comorbidities, cardiovascular parameters, adipose tissue, and liver histology. The age of HIV-infected participants was (median, interquartile range IQR) 48 y (42-51), with 76.2% females, a BMI of 41.4 kg/m2 (37.3-44.4), an antiretroviral duration of 16 y (8-21), current integrase strand transfer inhibitor (INSTI)-based regimen in 15 participants and non-INSTI regimen in 6 participants, and a CD4 count of 864/mm3 (560-1066). The age of controls was 43 y (37-51), with 78.9% females and a BMI of 39.2 kg/m2 (36.3-42.6). Anthropometric characteristics, comorbidities, and cardiovascular parameters did not differ according to HIV status and INSTI treatment. The number of macrophage crown-like structures in SCAT was lower in INSTI-treated participants than in HIV-uninfected participants (P = 0.02) and non-INSTI-treated HIV-infected subjects (P = 0.07). Hepatic steatosis and liver disease severity global score were lower in INSTI-treated participants than in non-INSTI-treated HIV-infected participants (P = 0.05 and P = 0.04, respectively). HIV-infected and HIV-uninfected subjects undergoing bariatric surgery presented a similar profile regarding anthropometric measures, cardiovascular parameters, and comorbidities. However, INSTI-treated participants presented milder SCAT and liver alterations than non-INSTI-treated participants.

Comparison of short-term outcomes between multi-port and single-port sleeve gastrectomy: a prospective study

Background: Single-incision laparoscopic surgery has attracted a great deal of interest in the surgical community in recent years, including bariatric surgery. Literature is scarce about operative and clinical outcomes of single port sleeve gastrectomy (SPSG) compared to conventional laparoscopy. SPSG has been proposed as an alternative to the multiport laparoscopic procedure; however, it has yet to meet wide acceptance and application.Methods: This was a prospective non-randomized clinical study, to evaluate the feasibility and short-term outcomes of SPSG in comparison to the conventional multiport sleeve gastrectomy (MPSG).Results: Weight loss, resolution of comorbidities, length of hospital stay, complications were almost comparable in both groups. Operating times were longer in SPSG group. Two patients only required re-laparoscopy, one in either group. There were no leakage or mortalities. Patients in the SPSG group had better wound satisfaction and less post-operative pain.Conclusions: SPSG is a safe, effective, and feasible surgical procedure for morbid obesity in selected individuals and comparable to the conventional laparoscopic technique in terms of outcomes. It has equally effective weight loss and resolution of comorbidities. It also has the added benefits of little/ no visible scarring and reduced postoperative pain.

Safety and effectiveness of reduced-port laparoscopic sleeve gastrectomy in Asian morbidly obese patients

Laparoscopic sleeve gastrectomy is the most frequently performed surgical intervention in patients with morbid obesity. Single-port sleeve gastrectomy (SPSG) and reduced-port sleeve gastrectomy (RPSG) are increasingly reported in the literature. This study compared the short-term outcomes of SPSG, RPSG, and conventional laparoscopic sleeve gastrectomy (CLSG). This is a single-center retrospective study of 238 morbidly obese patients, of whom 148 (62.2%) patients completed follow-up one year after surgery. Propensity score matching was performed on factors influencing the choice of approach, and fifty patients from the SPSG + RPSG and CLSG groups were successfully matched. The groups were comparable in postoperative weight loss, morbidity, pain, and resolution of obesity-related comorbidities. The percentage of excess weight loss after one year was 90.0% in the SPSG + RPSG group and 75.2% in the CLSG group (P < 0.001). Complication rates showed no significant difference. The CLSG group was superior in dyslipidemia remission (17 [37.0%] vs. 28 [63.6%], P = 0.018) in the total cohort; however, this difference disappeared after matching. Our results suggest that single-port and reduced-port approaches could be alternative choices for selected patients. As our study was limited by its retrospective nature and potential selection bias, further studies are necessary to set standardized guidelines for SPSG.

Single-port magnetic-assisted sleeve gastrectomy

Abstract Rationale: Sleeve gastrectomy is the most frequent surgery performed worldwide in bariatric surgery. In recent years, there has been an increase in the tendency to perform this procedure using a single port; however, to date, there have been no reports of this magnet-assisted surgery. We developed a magnet-assisted sleeve gastrectomy technique to demonstrate the use of magnets in different steps of the surgery to perform this procedure. Patient Concerns: A 38-year-old woman with a body mass index of 36.2 kg/m2 attended the clinic with the desire to lose weight in order to improve her living conditions. Diagnosis: Based on her weight and height, the patient's body mass index was diagnosed as obese grade II. During the examination by the multidisciplinary team, the patient presented with a blood pressure of 133/86 mm Hg and was diagnosed with hypertension. Intervention: The sleeve gastrectomy technique was performed in a standard manner using a single port located in the umbilicus and a 5-mm port in the right upper quadrant. In addition, we used a magnet positioned on the outside of the patient's abdomen, and a grasper coupled to a magnet was positioned in different parts of the cavity to assist in different steps of the surgery. Outcomes: The surgery was successfully completed with no intraoperative complications with the use of magnetic devices. The patient was discharged 36 hours postoperatively with nutritional indications. At the month follow-up the patient lost 7 kg of initial weight. Lessons: The use of a novel magnetic device can achieve a greater degree of ease in the face of difficulties associated with single-port sleeve gastrectomy.

Magnetic device in reduced port and single port bariatric surgery: First 170 cases experience

IntroductionMagnetic devices have been successfully used in bariatric surgery. To the date, the only reported use of the magnet was for liver retraction. Our purpose in this study is to demonstrate the safety and viability of using a magnetic system in different steps in single port and reduced port bariatric surgery. MethodsProspective and observational study was performed. Patients older than 18 years, undergoing primary laparoscopic sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and Roux-en-Y gastric bypass (RYGB) or revisional surgery by single-port or reduced-port approach between July 2020 and June 2021 were included. ResultsA total of 170 patients (mean BMI, 41.47kg/m2; mean age 36.92 yrs) completed laparoscopic bariatric surgery (54 single-port sleeve gastrectomy [SPSG], 16 reduced-port SG, 83 RYGB, 4 OAGB and 14 revision surgeries), using the magnetic surgical system in different steps of the surgery. Mean surgical time for SPSG and reduced-port SG was 65.52min and 59.36min respectively; and for RYGB 74.19min, OAGB 70.98min, and revisional surgeries 88.38min. As for intraoperative complications, 2.94% mild liver laceration without significant bleeding was reported. There were no 30-day mortalities and no major complications. ConclusionMagnetic assistance in single-port and reduced-port bariatric surgery is an innovative technique. With this prospective study we attempt to demonstrate the safety profile and potential uses that may improve the implementation of new surgical approaches in bariatric surgery.

Single-Port Sleeve Gastrectomy Compared With Conventional Laparoscopic Sleeve Gastrectomy: 5-Year Follow-up of Weight Loss, Comorbidity Resolution, and Cost.

Background. The Single-Port Instrument Delivery Extended Reach (SPIDER) surgical system is a safe revolutionary technology that defeated difficulties of single-incision surgery. We assessed the long-term outcomes of SPIDER sleeve gastrectomy (SPIDER SG) versus conventional laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients. Methods. Retrospective review of patients who underwent SPIDER SG or LSG in our center matched by the date of surgery (2012-2013). We reviewed weight loss results up to 5 years, complication rates, procedure and hospitalization durations, financial cost, and effect on comorbidities. Results. Patients underwent 200 SPIDER SG and 220 LSG. At baseline, SPIDER SG versus LSG patients had a mean body mass index of 43.8 ± 5.6 and 48.6 ± 8.1 kg/m2, respectively. At 1 year, both groups had comparable percentage of excess weight loss (%EWL). At 5 years, SPIDER SG had %EWL of 54.6 ± 24.8 compared with 57.8 ± 29.9 in LSG (P = .4). Nine SPIDER SG (4.5%) required conversion to LSG. Complications occurred in both groups: 4% versus 4.1% (P = .95). At 2-year follow-up, diabetes mellitus was reversed in 43% of SPIDER SG and 62% LSG. Despite a shorter hospital stay in SPIDER SG, the total cost was significantly higher ($2 041 477) compared with LSG ($1 773 834). The mean score of scar satisfaction was significantly more in SPIDER SG. Conclusions. SPIDER SG was safe with long-term effects on weight loss comparable to LSG. Despite the higher cost of SPIDER SG, a shorter hospital stay and better cosmesis were observed.

Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis.

Sleeve gastrectomy (SG) has become a frequent bariatric procedure. Single-port sleeve gastrectomy (SPSG) could reduce parietal aggression however its development has been restrained due to fear of a complex procedure leading to increased morbidity and suboptimal sleeve construction. The aim of this study was to compare the short-term outcomes of SPSG versus conventional laparoscopic sleeve gastrectomy (CLSG) with regards to morbidity, weight loss, and co-morbidity resolution. Between January 2015 and December 2016, data from all consecutive patients that underwent SPSG and CLSG in two institutions performing exclusively one or the other approach were retrospectively analyzed. Propensity score adjustment was performed on the factors known to influence the choice of approach. During the study period, 1122 patients underwent SG in both institutions (610 SPSG and 512 CLSG). From each group, 314 patients were successfully matched. A 15-min increase in operative time was observed during SPSG (P < 0.001). Postoperative morbidity was similar with a minor increase after SPSG (8.6 vs. 6.7%, P = 0.453). No differences in incisional hernia rates were observed (1.6 (SPSG) vs. 0.3% (CLSG), P = 0.216). Percentage of total weight loss was 31.1% and 28.2% in the CLSG and SPSG 12months after surgery, respectively (P = 0.321). Co-morbidities resolution 12months following the procedure was similar. SPSG can be performed safely with similar intraoperative and postoperative morbidity compared to CLSG. Weight loss and co-morbidities resolution at 1 year are equivalent. A 15-min longer operative time was the only negative side of SPSG.

A494 Single Port Sleeve Gastrectomy – Safety and Feasibility

A494 Single Port Sleeve Gastrectomy – Safety and Feasibility

A496 Single Port Sleeve Gastrectomy – Safety and Feasibility

A496 Single Port Sleeve Gastrectomy – Safety and Feasibility

Umbilical Single-Port Sleeve Gastrectomy as a Standardized Procedure: How to Do It? (Video)

Laparoscopic sleeve gastrectomy is the most common bariatric procedure worldwide, commonly performed using laparoscopic multiport. Feasibility and safety of single-port sleeve gastrectomy (SPSG) have been proved. We reported a standardized procedure describing the different steps as a reference for bariatric surgeons. Two news concepts are necessary: "surgical corridor," surgeon working in a small intraperitoneal area is less disturbed by excess abdominal fat and liver hypertrophy; "parietal space" is the area in the abdominal wall through the instruments are introduced, it's important to preserve this. The patient was placed in a seated position and we utilized 2.5-3cm skin incision in the umbilicus. Single trocar was placed; a flexible camera and double curve grasper are needed to decrease grasper conflict. Dissection of the stomach was obtained by 47cm Thunderbeat (Olympus-Japan), the sleeve of the stomach was created over a 36F calibrator. A 60-mm roticulating XL staplers were used and beginning 4cm proximal to the pylorus next to the gastro-pancreatic ligament and heading toward the left side of the gastro-esophageal junction. We utilized a linear staple line using 4 to 7 staples; hemostasis is controlled by bipolar coagulation. Specimen was removed easily through the single-site trocar. Parietal defect is easily repaired. Operating time is 41min. The patient was discharged at day 1 without naso-gastric tube or drainage. No complication. Umbilical SPSG is nowadays a standardized procedure based on the surgical corridor and the parietal space. This is a safe and reproductive procedure applicable in most patients with massive obesity but necessitate learning curve.

Laparoendoscopic Single-Site Bariatric Surgery: A Review of Single-Port Laparoscopic and Endoscopic Bariatric Treatments.

Bariatric surgery is an established and effective treatment, not only to combat morbid obesity, but also to address associated metabolic comorbidities. At this time, the cutoff for bariatric or metabolic surgery in terms of body mass index (BMI) is decreasing, making it more feasible for certain individuals to consider minimally invasive surgical options. Innovations in the technique have led to the application of laparoendoscopic single-site surgery (LESS) in the field of bariatrics, which uses a single or no incision in the performance of weight-reducing surgery. To date, there is no consensus regarding patient selection though most candidates for single-port bariatric surgery are female. Some doctors suggest that single-port bariatric surgery may not be recommended in patients with BMI of more than 50 kg/m2, height of more than 180 cm, and xiphoid–umbilicus distance of more than 20 cm. Sleeve gastrectomy (SG) is now the most widely performed bariatric surgery worldwide and single-port SG (SPSG) is already established as a routine procedure in various institutions. Current evidence shows that SPSG is less painful and demonstrates higher rates of patient satisfaction regarding the wound. SPSG is feasible and is recommendable in patients who meet certain criteria. Furthermore, endoscopic treatment modalities such as intragastric balloons and endoluminal malabsorptive devices are being developed to bridge the gap between medical and surgical treatments. Nevertheless, there is still insufficient evidence to prove the superiority of LESS bariatric surgery over conventional laparoscopic surgery. Large, well-designed prospective analyses are needed to determine the criteria for selecting patients suitable to undergo LESS bariatric surgery and to predict the procedure’s role in the growth of bariatric surgery.

Safety and Feasibility of Single-Port Sleeve Gastrectomy Following Liver Transplantation.

Safety and Feasibility of Single-Port Sleeve Gastrectomy Following Liver Transplantation.

Single Port Sleeve Gastrectomy as Safe Procedure in the Treatment of Morbidly Obese Patients

Background: Laparoscopic sleeve gastrectomy had gained popularity and acceptance among bariatric surgeons, mainly as a result of its low morbidity and mortality. Single-incision laparoscopic surgery (SILS), the most recent development in minimally invasive surgery, allows operations to be carried out through, only a single incision. The aim of our study was to evaluate the efficacy and safety of a laparoscopic single-incision sleeve gastrectomy for morbid obesity in comparison with multiport laparoscopic sleeve gastrectomy. Patients and methods: This is a prospective comparative study conducted between June 2012 to November 2015, which included 35 morbidly obese patients, divided into 2 groups. Group (A) included 18 patients who underwent multiport laparoscopic sleeve gastrectomy and group (B) included 17 patients who underwent single-incision laparoscopic sleeve gastrectomy. Conclusion: Laparoscopic single-incision sleeve gastrectomy seems to be safe and effective as same as conventional multiport sleeve gastrectomy. However, additional work must be carried out before these techniques achieve the level of standardization.

Three-Port Laparoscopic Sleeve Gastrectomy: A Novel Technical Modification.

Laparoscopic sleeve gastrectomy has rapidly been adopted as a primary surgical procedure in bariatric patients. The technique of multiport sleeve gastrectomy is described using 4 to 6 ports and an additional port for a liver retractor. A technique of single-port sleeve gastrectomy has been described, the principal advantages of which appear to reduced postoperative pain and an improved cosmetic outcome. In this paper we describe a novel, and easily reproducible technique for the performance of a sleeve gastrectomy using only 3 ports that does not compromise the procedure and may offset the disadvantages of a multiport technique.

Postoperative pain after conventional laparoscopic versus single-port sleeve gastrectomy: a prospective, randomized, controlled pilot study

BackgroundLaparoscopic approach is the gold standard for surgical treatment of morbid obesity. The single-port (SP) approach has been demonstrated to be a safe and effective technique for the treatment of morbid obesity in several case control studies. ObjectivesCompare conventional multiport laparoscopy (LAP) with an SP approach for the treatment of morbid obesity using sleeve gastrectomy in terms of postoperative pain using a visual analog scale (VAS) 0–100, surgical outcome, weight loss, and aesthetical satisfaction at 6 months after surgery. SettingUniversity Hospital, Spain. MethodsRandomized, controlled pilot study. The trial enrolled patients suitable for bariatric surgery, with a body mass index lower than 50 kg/m2 and xiphoumbilical distance lower than 25 cm. Patients were randomly assigned to receive LAP or SP sleeve gastrectomy. ResultsA total of 30 patients were enrolled; 15 were assigned to LAP group and 15 to SP group. No patients were lost during follow-up. Baseline characteristics were similar in both groups. A significantly higher level of pain during movement was noted for the patients in the LAP group on the first (mean VAS 49.3±12.2 versus 34.1±8.9, P = .046) and second days (mean VAS 35.9±10.2 versus 22.1±7.9, P = .044) but not the third day (mean VAS 20.1±5.2 versus 34.12.9 ±4.3, P = .620). No differences regarding pain at rest, operative time, complications, or weight loss at 6 months were observed. Higher aesthetical satisfaction was noticed in SP group. ConclusionsIn selected patients, SP surgery presented less postoperative pain in sleeve gastrectomy compared with the conventional laparoscopic approach with similar surgical results.

Single-port sleeve gastrectomy for super-obese patients

BackgroundLaparoscopic sleeve gastrectomy, which has become a primary bariatric procedure in super-obese patients (SOPs), is associated with considerable weight loss. Traditionally, laparoscopic sleeve gastrectomy requires 4–7 skin incisions. Single-port laparoscopic surgery is now feasible for bariatric surgery. ObjectivesTo evaluate the feasibility and safety of single-port sleeve gastrectomy (SPSG) for SOPs. SettingDepartment of Abdominal and Minimally Invasive Surgery, Antoine Beclere Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, France. MethodsEvaluation of the outcomes on patients who underwent surgery consecutively from June 2010 to June 2013 with follow-up of>1 year. ResultsIn total, 62 patients (46 women, 16 men) underwent SPSG. The median age was 41 years (range 19–67), median preoperative body mass index was 52.2 kg/m2 (range 50–87), median operative time was 89 minutes (range 42–212). Twelve patients required additional trocars, and 4.8 % developed complications. The median postoperative stay was 4 days (range 3–9 days) and median follow-up period was 21 months (range 12–48 months) with no loss of follow-up. The median percentage of excess weight loss was 69.7% (range 52%–100%) and percentage of weight loss was 36% (28%–56%) for the same period. ConclusionSPSG for SOPs was found to be technically feasible, reproducible, and safe in this series.

Short-term results of single-port sleeve gastrectomy in adolescents with severe obesity

BackgroundDietary and lifestyle modifications, which are commonly proposed to overweight or obese youth, lack efficacy in individuals who are severely obese. Early results with bariatric procedures in obese adolescents suggest that weight loss and safety are comparable or better than seen in adults. One of these procedures, laparoscopic sleeve gastrectomy, is commonly performed using multiple ports. MethodsWe selected single-port sleeve gastrectomy (SPSG) as a minimally invasive surgery to be tested in severely obese adolescents. Prospective clinical and biochemical data were collected from 16 young severely obese patients who underwent SPSG. The setting was a university hospital. ResultsThe mean age of the cohort was 17.8 years (12 girls, 4 boys). The individuals’ average weight was 125.5 kg and their average body mass index was 45.3 kg/m2. All patients were insulin-resistant and 6 showed hypertriglyceridemia. The median operating time was 66 minutes, and there were no intraoperative complications. No conversion to open surgery was required. No patient required additional trocars and no patient had postoperative complications. The median hospital stay was 3 days. After a one-year follow-up, the average weight decrease was 40.3 kg, resulting in a decrease in excess weight loss by 70.61%. Insulin-resistance decreased in 16/16 patients and hypertriglyceridemia decreased in 5/6 patients. ConclusionSPSG seems safe and effective in the short term in severely obese adolescents.