Single Incision Sleeve Gastrectomy Utilizing Spider® Surgical System: Case Series of 18 Patients

Shyam Dahiya, MD. Tri-City Regional Medical Center, Hawaiian Gardens, CA


Introduction: Single incision laparoscopic surgery has garnered wide interest in a number of specialties. A common limitation cited for many single incision methods is the lack of instrument triangulation and the need to cross instruments. The SPIDER® Surgical System (TransEnterix, Durham, NC) is a technology for single incision surgery that provides instrument triangulation and eliminates instrument crossing. This is a report of a single surgeon case series of 18 laparoscopic, single incision sleeve gastrectomies utilizing the SPIDER® Surgical system to assess feasibility.

Methods and Procedures: A 12mm trocar is inserted at the umbilicus in the left portion of the umbilical ring. Pneumoperitoneum is obtained and the abdominal cavity is inspected. The SPIDER device is inserted next to the 12mm trocar within the same umbilical incision (through a separate fascial incision) on the right portion of the umbilical ring. The total skin incision length is approximately 3.5cm. A 5mm bariatric length scope is inserted through the SPIDER device for visualization. Two flexible, atraumatic graspers are inserted into the flexible instrument channels of the SPIDER device for retraction and manipulation of gastric tissue. A 5mm laparoscopic vessel sealing device is then introduced at the umbilicus through the 12mm trocar. The pylorus is identified, and the gastrolysis begins approximately 4 cm from the pylorus. The surgeon uses their left hand to control the left flexible instrument of the SPIDER, and uses their right hand to control the vessel sealer. The assistant controls the right flexible instrument of the SPIDER device for counter-traction and lifting of gastric tissue. Once the gastrolysis is complete, a 34 Fr gastric tube is inserted to guide the sleeve formation. An articulating stapler is introduced through the 12mm trocar at the umbilicus, and the gastric tissue is manipulated into the proper position using the SPIDER flexible instruments. A buttress material is used with each stapler cartridge, and the stomach is divided to form the sleeve. The gastric specimen is grasped by a rigid grasper through the SPIDER device, and the specimen is removed as the SPIDER device is removed from the abdomen.

Results: A total of 18 sleeve gastrectomies were done by a single surgeon utilizing the SPIDER Surgical System. The mean age of patients was 39 years (+/- 13 standard deviation, 23 min, 61 max). The mean BMI was 43 (+/- 1 5 standard deviation, 39 min, 59 max). The mean total operative time was 98 minutes (+/- 58 standard deviation, 51 min, 200 max). The mean follow up period was 94 days (+/- 78 standard deviation, 7 min, 311 max). In 16 of 18 cases, no Nathanson liver retractor was used because the SPIDER left flexible arm provided all necessary liver retraction. No interoperative or post-op complications were observed. No cases were converted to open, and no cases required additional ports.

Conclusions: The SPIDER® Surgical System appears feasible as a single incision system to perform gastric sleeves. Further study of this novel technology is recommended

Session Number: Poster – Poster Presentations
Program Number: P619
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