Patricio Cal, MD, Luciano Deluca, MD, Tomas Jakob, MD, Liliana Parasporo, MD, Ezequiel Fernandez, MD. CRQO
Background: Laparoscopic bariatric surgery has been performed safely since 1991. In a persistent search for fewer and smaller scars, single port and acuscopic surgery or even NOTES have been implemented. The goal of this study is to analyze the safety and feasibility of using a low cost incisionless liver retraction compared to a standard laparoscopic retractor for sleeve gastrectomy.
Methods & Procedures: Candidates for sleeve gastrectomy that fulfilled 1991 NIH criteria for bariatric surgery were selected. Those younger than 18 and/or with prior upper-left quadrant surgery were excluded. All patients signed written consent. Patients were randomized 1:1 to either a standard 5 port technique with a fan-type liver retractor through a 5mm port (group A); or a 4 port technique with the liver retracted by a polypropylene 1 suture passed through the right crura and retrieved at the epigastrium with the use of a fascia closure needle (group B). All surgeries were performed by the same surgeon. Surgery length from insertion of first port to withdrawal of the last was the primary endpoint. Anthropometric data, % of pre-surgical total weight loss (%PTWL), visualization of the surgical field, complications inherent to liver retraction and postoperative morbidity were recorded.
Sample size was calculated to detect a 3-minute difference in surgical time (10% of surgeons previous experience, 31 min, SD=4.4) with an alpha error of 0.05 and a 90% power.
Results: One hundred patients were included. Groups were comparable (Group A vs B) in age (42.9 vs 42.7 years); BMI (45.1 vs 44.5 kg/m2) and %PTWL (11.9 vs 11.4%). Females accounted for 90% in each group.
Main surgical length was 30.4±4.6 minutes for Group A and 29.6±4.7 minutes for Group B (P=0.41). Visualization was considered very good in 80% vs 82%, good in 16% vs 12% and poor in 4% vs 6% (P=NS). Two patients from each group (4%) had self-limited bleeding from the liver dew to retraction. No 30-day morbidity was observed in either group.
Conclusions: In the ongoing quest for incisionless surgery, liver retraction using a polypropylene suture resulted to be effective and inexpensive. Visualization was comparable to a standard liver retractor. Duration of surgery was similar. This low-cost alternative may eliminate the need for expensive instruments and reduce the number of scars without sacrificing the safety and quality of sleeve gastrectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87101
Program Number: P615
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster