Introduction: Single incision surgery is an evolving technique which aims to minimize pain and scarring related to multiple laparoscopic incisions. This video describes a modified single incision laparoscopic approach for adjustable gastric band placement in a 28 year old female with a BMI 48.75.
Methods: Although we originally used a true single incision technique and placed all instruments through one subcostal incision, we currently favor a modified approach which includes standard midepigastric placement of a Nathanson liver retractor and placement of three working ports in the left upper quadrant. The three working ports include two 5mm low profile trocars placed on either side of a 12mm optical entry trocar; these trocars are placed closely together within a 4.5cm distance and the skin bridges are incised at the end of the procedure to allow implantation of the band reservoir. A conventional 45 degree 5mm laparoscope is used for visualization. A hand-over-hand motion facilitates the use of conventional straight laparoscopic instruments in the setting of limited range of motion due to the single incision approach. Two stay sutures are placed in the stomach and perigastric fat and externalized through the 12mm trocar; external traction on these sutures provides suitable exposure to the angle of His and the right crus. An articulating 5mm grasper is used to create the retrogastic tunnel and retrieve the band into the appropriate position. An automated suturing device is used to create an anterior gastric plication using an intracorporeal knot-tying technique. The band tubing is externalized through the 12mm trocar and the working port incisions are joined together to allow implantation of the band reservoir. The final result is a 4.5cm incision in the left upper quadrant, in addition to the 5mm incision for the liver retractor.
Results: Operative time was 1 hour and 50 minutes with minimal blood loss. The patient did well postoperatively with no complications. She had a negative routine swallow study and was discharged home on postoperatively day 1.
Conclusions: While single incision surgery is still evolving, we believe that this technique for adjustable gastric band placement is feasible and provides patients with improved cosmesis. Clinical trials may demonstrate other potential benefits including less pain and a faster recovery.
Session: Podium Video Presentation
Program Number: V037