Laparoscopic SPIDER sleeve gastrectomy: description of technique.

Michel Gagner, MD, Davit Sargsyan, MD, Moataz Bashah, MD, Mohammed Al Kuwari, MD, Mohammed Rizwan

Hamad General Hospital, Doha, Qatar

In this video we present a laparoscopic sleeve gastrectomy performed with SPIDER surgical system. SPIDER is a laparoscopic platform of flexible instruments introduced into the abdomen through a single port.

We start the procedure with creation of pneumoperitoneum in a conventional open way through a right paraumbilical incision and then introduce the SPIDER system. The system is introduced in a protective plastic shield which is removed afterwards. A small 3mm stub incision is made in epigastrium for the liver retractor. Left lobe of the liver is retracted laterally and is fixed in this position. Second paraumbilical incision is made on the left side of the umbilicus and additional port for stapler is introduced.

Then two flexible manipulating graspers are introduced into the abdomen through 2 articulating flexible ports. We start the procedure with dividing the gastrosplenic ligament with harmonic scalpel. We use long 45cm harmonic to facilitate the dissection at the angle of His. Short gastric vessels are divided and left diaphragmatic crus is exposed. At this point care must be taken not to injure the spleen and diaphragm. After that fat pad is dissected off thus completely exposing angle of His.

Procedure then continued with dissection of gastrocolic ligament. Dissection is continued distally till pylorus is exposed and posterior attachments with pancreas are divided.

Once dissection is complete a 38F calibration MidSleeve tube with balloon is introduced into the stomach down to the pylorus. Balloon is inflated with 10cc of saline and thus fixed in the pylorus.

Articulating stapler loaded with buttressed 60mm green Ethicon or black Covidien cartridge is introduced and placed 4cm proximal to the pylorus. Stapler is closed and fired. Stomach is transected towards the angle of His by sequential firing of the same size stapler.

Once stomach is transected, methylene blue leak test is performed and the calibration tube is taken out. Specimen is extracted through the right paraumbilical incision with the SPIDER system.

Wounds are closed with subcuticular absorbable stitches resulting in 2 almost invisible paraumbilical scars. Patients usually don’t require narcotic analgesia and are discharged next day once tolerating fluid diet.

Session: Video Channel Day 1

Program Number: V055

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