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
industry
- More presentations/publications
- More tools to sell by the ndustry that results in more profit
Disadvantages
- 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