First Case Series of Microlaparoscopic Adjustable Gastric Banding: Maintaining Ergonomics and Laparoscopic Prinicples of Triangulation While Reducing Scars

Emma J Patterson, MD, Jamie Laut, MEd. Oregon Weight Loss Surgery LLC, Portland OR; Legacy Good Samaritan Medical Center, Portland OR; Wilshire Surgery Center, Portland OR

INTRODUCTION
Many recent potential advances such as single incision laparoscopic surgery (SILS) require additional (often disposable) devices or for the surgeon to employ a less ergonomic approach. Microlaparoscopic Adjustable Gastric Banding (MLAGB) is a novel modification that utilizes smaller, reusable instruments resulting in tiny scars, and yet maintains the basic laparoscopic principle of triangulation. This is a pilot study to assess the feasibility and safety of MLAGB.

METHODS AND PROCEDURES
Between March and September of 2011, 10 of 49 consecutive adult patients undergoing banding by a single surgeon were offered the MLAGB approach. Inclusion criteria were: relatively young and healthy; lower BMI; and a short, thin upper abdomen that was scar-free preoperatively. A 15 mm trocar was placed at the umbilicus, and three or four 2.9 mm cannulas in the upper abdomen. The 2.7 mm microlaparoscopic instruments are made from a ceramic-titanium alloy (TransEnterix, Research Triangle, NC). Data was collected prospectively in an IRB-approved registry.

RESULTS
MLAGB was performed successfully on all patients, and two had concurrent hiatal hernia repairs. They were 90% female, had a median age of 35 years (range 22 to 46 years), and a median body max index (BMI) 39.4 kg/m2 (range 34.3 to 44.6). Median operative time was 56.5 minutes (range 52 to 76 minutes). None of the patients have had complications. Four graspers were broken while attempting to lock the buckle of the band. This step is now performed with one micro grasper in the right upper quadrant and one regular bariatric needle driver through the umbilical trocar.

CONCLUSIONS
This early experience with MLAGB suggests that the instruments are strong enough to perfrom gastric banding surgery safely on some highly selected bariatric patients, but not strong enough to lock the band. MLAGB may appeal to patients due to the tiny scars, which help protect their privacy about surgery, and may appeal to surgeons due to the maintenance of ergonomic and laparoscopic principles.

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