Rachel B Scott, DO, Rima Ahmad, MD, Randy L Tigue, MD, Keith A Zuccala, MD. Danbury Hospital
Introduction: Microlaparoscopic or “mini” laparoscopic instruments have been utilized in urology and obstetrics and gynecology for almost two decades. In the field of general and bariatric surgery, however, there remains limited use of such instruments despite the potential for decreased postoperative pain, decreased narcotic use and faster return to daily activities with smaller incisions. Through this study we hypothesize that the utilization of microlaparoscopic trocars and instruments, defined as instruments 3mm in diameter or less, is a safe and effective method for surgery in the bariatric population.
Materials and Methods: A single center retrospective study was conducted, looking at patients who underwent roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy, performed with the microlaparoscopic technique. This was defined as the utilization of three 3mm ports, and one 15mm port for stapling and specimen extraction. Patient demographics, intraoperative and postoperative complications, operative details and postoperative course were recorded for all patients.
Results: A total of 448 patients underwent microlaparoscopic bariatric surgery at our institution from July 2008 to July 2016, of which 262 underwent RYGB and 186 underwent sleeve gastrectomy. The median BMI for the groups was 46 and 44, respectively, and the maximum BMI was 75 and 80, respectively. There were 8 instances of the need to upsize trocars (1.7%) and no cases were converted to open. Intraoperative complications occurred in 4 patients (0.9%) undergoing RYGB, and no sleeve gastrectomy patients. The median length of stay was 2 days for RYGB patients and 1 day for sleeve gastrectomies. A total of 26 patients were readmitted within 30 days, 19 RYGB patients (7.2%) and 7 sleeve gastrectomies (3.7%).
Conclusions: The utilization of microlaparoscopic instruments is safe and effective in the bariatric population. Length of stay, postoperative complication rates and readmission to the hospital are acceptable and comparative to traditional laparoscopic approaches for these procedures.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80704
Program Number: P436
Presentation Session: Poster (Non CME)
Presentation Type: Poster