Single-incision Laparoscopic Gastric Bypass for Morbid Obesity – Using Conventional Trocars and Instruments

C Palanivelu, MS, FACS, P Praveen Raj, MS, P Senthilnathan, MS, R Parthasarthi, MS, N Anand Vijay, MS, Chandra Maliteeswaran, MS, B Vijay, MS

GEM Hospital

Conventional laparoscopic Roux-en-Y gastric bypass (LRYGB) is gold standard for bariatric surgery, but the procedure requires five to seven incisions for placement of multiple trocars and thus may produce less-than-ideal cosmetic results. Recently, single-incision laparoscopic surgery (SILS) has been used for bariatric procedures, and this surgery is considered a type of minimally invasive surgery. When SILS is performed via the transumbilical route, the resultant abdominal wound is hidden and the cosmetic outcome is better.Here we present one of our cases of Single Incision transumbilical Roux en Y gastric bypass Surgery without usage of any commercially available single port systems

In this high Definition video, we show a single incision Laparoscopic Roux en Y gastric bypass.
-Step 1 involves creating a transverse umbilical scar and raising umbilical flaps on either side
-Four trocars (12mm, two 5mm and one 10mm) are inserted directly through the fascia at different sites after creating the pneumoperitoneum
-the liver was retracted using a novel liver suspension technique of passing polyamide suture through the liver and suspending the liver using a piece of corrugated rubber tube
-The gastric pouch of 50ml is created in standard fashion using blue cartridges
-the gastrocolic omentum is divided in the midline
-the jejunum was divided at 75 cm and the jejuno-jejunostomy was done with 100cm Roux limb using linear staplers and intracorporeal sutures
-The gastrojejunostomy was performed using 30mm liner staplers and the defect closed with 2-0 PDS with intracorporeal suturing
Single Incision Laparoscopic RYGB though technically challenging is possible and avoids multiple ports in morbidly obese patients.

Session: Video ChannelDay 3

Program Number: V113

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