Kathryn B Muir, MD, William V Rice, MD. William Beaumont Army Medical Center
Laparoscopic sleeve gastrectomy (LSG) has become an acceptable primary stand-alone procedure for metabolic and weight-loss surgery. Traditional LSG involves multiple small abdominal incisions, similar to traditional laparoscopic cholecystectomy. Sleeve gastrectomy has also been performed using the single incision laparoscopic surgery (SILS) technique, to minimize scarring and improve ultimate cosmetic outcome. SILS is technically challenging due to the crossover of instruments. Recently, the single port instrument delivery extended reach (SPIDER®) surgical system has been introduced as another single incision modality for performing sleeve gastrectomy. This system minimizes the number of incisions needed while eliminating the technical challenges of instrument crossover. Use of this technique has been reported previously, however, outcomes of SPIDER® sleeve gastrectomy have not been compared to outcomes of traditional LSG. We hypothesized SPIDER® sleeve gastrectomy would not be inferior to traditional LSG.
Methods and Procedures
We performed a retrospective review of a prospectively collected database involving patients undergoing surgery between Aug 2011 and Sep 2013. All cases were performed by a single bariatric surgeon and at a single institution. Thirty-two patients underwent SPIDER sleeve gastrectomy versus thirty who underwent LSG. Our primary outcomes were change in BMI and percent excess weight loss (%EWL) at 6 months post-operatively. Secondary outcomes included length of operative time, intraoperative estimated blood loss (EBL), and overall complications.
The demographics of our patients were examined and the only significant difference between the cohorts was mean initial BMI (SPIDER®=42.1, LSG=46.5, p<0.001). At 6 months post-operatively, mean %EWL was higher in the SPIDER® cohort (59.1%) than in the LSG cohort (48.3%) (p<0.005). This corresponded with an overall lower mean BMI in the SPIDER® cohort at 6-months versus those who underwent traditional LSG (31.1 and 35.5, respectively, p<0.0001). At the 6 month post-operative interval, despite differences in initial BMI, the overall change in BMI in each cohort was equivalent (SPIDER®=11.1, LSG=11.0, p=0.94). Mean operative time was longer in SPIDER® sleeve gastrectomy (107.4 min) compared to LSG (87.4 min) (p<0.001). EBL was not different between the two techniques (32.1mL and 32.3mL, p=0.94). With regard to complications, there was one post-operative hemorrhage in each group; one surgical site infection in the LSG cohort, and one negative diagnostic laparoscopy in the SPIDER® cohort due to uncharacteristic abdominal pain on post-operative day #1.
Based on the results at 6 months post-operatively, SPIDER® sleeve gastrectomy is not inferior to LSG with regard to decrease in BMI or %EWL. The increased %EWL observed in the SPIDER® cohort is likely due to patient selection bias given the use of a new technique, though other explanations cannot be excluded. This retrospective study shows that the SPIDER® technique is a viable alternative to traditional LSG with regard to weight-loss outcomes.