Patrick Noel, MD, Marius Nedelcu, MD. Casamance Private Hospital.
INTRODUCTION : SPIDER (Single Port Instrument Delivery Extended Reach) surgical system is a revolutionary surgical platform that offers the triangulation during the surgical procedure eliminating the crossover of the instruments, one of the major limitations of the single access surgery.
METHODS: The purpose of this study was to analyze our initial experience with 10 patients who underwent SPIDER sleeve gastrectomy at the Hospital Prive Casamance between November 2012 and April 2013. All patients were reviewed in outpatient clinic for postoperative control at 1, 3 and 6 months. In addition to the clinical examination, the 1-month postoperative consultation also included a satisfaction survey questionnaire, according to the Moorehead – Ardelt scale.
RESULTS: All patients were women and the average age was 41.5 year old (range 27-52) . The mean BMI was 40.11 (range 37.2-44.3). The intervention was completed by SPIDER approach in all patients without "conversion" to classical laparoscopy or open surgery. The mean operative time was 61 minutes (+ / – standard deviation 15.22 min). The mean BMI at 1 month was 35.5 (+/-SD 3.58) with an average EWL of 32.9 % (+/-SD 8.56%). At 3 months the mean BMI was 32.4 (+/- SD 2.78) with an average EWL of 52.7 % (+/-SD 8.64 %). At 6 months the mean BMI was 29.9 (+/- SD 2.60) with an average EWL of 68.8 % (+/- SD 8.38 %). Regarding the comorbidities, a complete remission of these was observed in 4 patients, an improvement in 3 others and no change in the last patient . The average hospital stay was 3.1 days. The average follow-up period was 161 days (+/- SD 57.4 days). There was no mortality and no intraoperative complication was recorded.
CONCLUSIONS: The SPIDER surgical platform seems feasible and effective as a minimally invasive approach for sleeve gastrectomy allowing easy and efficient operating procedure compared to other systems of single port surgery. Prospective long-term studies are recommended before validating this approach as comparable in terms of efficiency to the conventional laparoscopic surgery.