Bariatric Surgery: Reduced Port Techniques

First submitted by:
Shawn Tsuda
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Preoperative Considerations

In making the case for LESS in Bariatric Surgery, some considerations are:

  • Does the bariatric patient care about fewer incisions?
  • What is the risk profile for this technique?
  • What is the impact on the surgeon’s experience?

Patient Selection

Which factors increase the technical challenges with Single port technique?

  • BMI
  • Central Obesity
  • Liver size
  • Hiatal Hernia
  • History of Previous surgery

Possible benefits for patients

  • Better Cosmesis?
  • Less Pain?
  • Patient preference?
  • Scarless surgery?

Benefits for surgeons and

  • More presentations/publications
  • More tools to sell by the ndustry that results in more profit


  • Prolonged OR time – result in more anesthesia related adverse events
  • Poor exposure/ loss of critical view
  • More intra-op. complications
  • Lack of triangulation and less dexterity
  • No traction or counter traction
  • More umbilical hernias that might result in serious postoperative complications
  • Requires retraining of master surgeons resulting in lack of surgeons acceptance
  • No insurance coverage
  • Lack of data and 10 year follow up
  • Less pain ? Where is the data ?
  • More direct and indirect costs
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