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Transumbilical single access laparoscopic sleeve gastrectomy plus 1.8mm trocarless grasping forceps
Background: Transumbilical single access laparoscopy (TSAL) has gained interest over the last decade. However, in bariatric surgery, it still remains difficult due to the fact that the umbilicus is not a landmark, and it is frequently localized too far from the operative field. In selected patients, it can be considered and offered.
Video: A 29-year-old morbidly obese woman with a BMI of 40 underwent TSAL sleeve gastrectomy. Two reusable ports and curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany) were placed in the umbilicus. The chosen method to perform sleeve gastrectomy was a medial-to-lateral approach (gastric division followed by greater curvature mobilization), and the resection of the gastric antrum. Gastric division was performed under the control of a long, rigid, 30-degree scope (Karl Storz). To expose the hiatal region and the angle of His, a 1.8mm trocarless grasping forceps according to DAPRI (Karl Storz) was inserted underneath the xiphoid process and placed against the diaphragm below the left liver lobe. Some absorbable sutures between the staple lines were finally placed, and no drain was left into the abdominal cavity. The specimen was removed transumbilically, after joining the three used windows together at the umbilical aponeurosis.
Results: Laparoscopy took 94 minutes and perioperative bleeding was 30cc. Umbilical scar length was 25mm. No postoperative complications were noted and the patient was discharged on postoperative day 4.
Conclusions: TSAL sleeve gastrectomy can be offered to selected obese patients. The use of reusable material and curved tools make it possible not to increase the cost of the procedure due to TSAL, and to establish intracorporeal and extracorporeal working triangulation.
G Dapri
Surgical intervention
3 years ago
1782 views
63 likes
0 comments
08:13
Transumbilical single access laparoscopic sleeve gastrectomy plus 1.8mm trocarless grasping forceps
Background: Transumbilical single access laparoscopy (TSAL) has gained interest over the last decade. However, in bariatric surgery, it still remains difficult due to the fact that the umbilicus is not a landmark, and it is frequently localized too far from the operative field. In selected patients, it can be considered and offered.
Video: A 29-year-old morbidly obese woman with a BMI of 40 underwent TSAL sleeve gastrectomy. Two reusable ports and curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany) were placed in the umbilicus. The chosen method to perform sleeve gastrectomy was a medial-to-lateral approach (gastric division followed by greater curvature mobilization), and the resection of the gastric antrum. Gastric division was performed under the control of a long, rigid, 30-degree scope (Karl Storz). To expose the hiatal region and the angle of His, a 1.8mm trocarless grasping forceps according to DAPRI (Karl Storz) was inserted underneath the xiphoid process and placed against the diaphragm below the left liver lobe. Some absorbable sutures between the staple lines were finally placed, and no drain was left into the abdominal cavity. The specimen was removed transumbilically, after joining the three used windows together at the umbilical aponeurosis.
Results: Laparoscopy took 94 minutes and perioperative bleeding was 30cc. Umbilical scar length was 25mm. No postoperative complications were noted and the patient was discharged on postoperative day 4.
Conclusions: TSAL sleeve gastrectomy can be offered to selected obese patients. The use of reusable material and curved tools make it possible not to increase the cost of the procedure due to TSAL, and to establish intracorporeal and extracorporeal working triangulation.
Laparoscopic sleeve gastrectomy for morbid obesity in a superobese woman
Laparoscopic sleeve gastrectomy has become a genuine morbid obesity procedure. Its frequency of use is quickly increasing as compared to other interventions. The rationale for such a success stems from the fact that the procedure is easy to perform, and weight loss is comparable to laparoscopic Roux-en-Y gastric bypass at least during the first three years. Its main immediate postoperative complication is the occurrence of fistula at the superior part of the cardia. Remotely, increased gastroesophageal reflux and strictures at the middle part of the stomach (at the incisura) can be observed. Although the technique seems easy, it should be performed in an extremely rigorous fashion to minimize complications. This video demonstrates the performance of a stepwise sleeve gastrectomy. Authors lay special emphasis on the entire steps which allow to reduce the risk of complications.
A Cardoso Ramos, M Galvao Neto
Surgical intervention
5 years ago
6645 views
86 likes
0 comments
19:26
Laparoscopic sleeve gastrectomy for morbid obesity in a superobese woman
Laparoscopic sleeve gastrectomy has become a genuine morbid obesity procedure. Its frequency of use is quickly increasing as compared to other interventions. The rationale for such a success stems from the fact that the procedure is easy to perform, and weight loss is comparable to laparoscopic Roux-en-Y gastric bypass at least during the first three years. Its main immediate postoperative complication is the occurrence of fistula at the superior part of the cardia. Remotely, increased gastroesophageal reflux and strictures at the middle part of the stomach (at the incisura) can be observed. Although the technique seems easy, it should be performed in an extremely rigorous fashion to minimize complications. This video demonstrates the performance of a stepwise sleeve gastrectomy. Authors lay special emphasis on the entire steps which allow to reduce the risk of complications.
Occurrence of a rare complication during laparoscopic sleeve gastrectomy
Nowadays, sleeve gastrectomy is a common procedure frequently performed laparoscopically in the management of morbid obesity. This intervention as proven to be efficient in comparison to laparoscopic Roux-en-Y gastric bypass (LRYGB) regarding weight loss and revision of obesity-related co-morbidities such as diabetes mellitus and high blood pressure. Today, in France, selection of the surgical technique (e.g., sleeve gastrectomy, LRYGB) depends on the patient should preoperative work-up be strictly normal. If not, the surgeon will have to make a decision as to which technique should be used. Postoperative complications related to bariatric surgery are currently well-known (fistula, bleeding, abscess) and are managed in a multidisciplinary way by radiologists, endoscopists and surgeons. Here, we present the case of a rare perioperative complication related to the incidental stapling of the nasogastric tube during gastric division. This complication mainly highlights shortcomings in the interaction between the surgical team and anesthesiologists during placement and retrieval of calibration and nasogastric tubes. In the present case, this complication was immediately demonstrated and it was managed laparoscopically.
L Marx, M Vix, J Marescaux
Surgical intervention
6 years ago
2931 views
26 likes
0 comments
08:29
Occurrence of a rare complication during laparoscopic sleeve gastrectomy
Nowadays, sleeve gastrectomy is a common procedure frequently performed laparoscopically in the management of morbid obesity. This intervention as proven to be efficient in comparison to laparoscopic Roux-en-Y gastric bypass (LRYGB) regarding weight loss and revision of obesity-related co-morbidities such as diabetes mellitus and high blood pressure. Today, in France, selection of the surgical technique (e.g., sleeve gastrectomy, LRYGB) depends on the patient should preoperative work-up be strictly normal. If not, the surgeon will have to make a decision as to which technique should be used. Postoperative complications related to bariatric surgery are currently well-known (fistula, bleeding, abscess) and are managed in a multidisciplinary way by radiologists, endoscopists and surgeons. Here, we present the case of a rare perioperative complication related to the incidental stapling of the nasogastric tube during gastric division. This complication mainly highlights shortcomings in the interaction between the surgical team and anesthesiologists during placement and retrieval of calibration and nasogastric tubes. In the present case, this complication was immediately demonstrated and it was managed laparoscopically.
Staple line failure during NOTES sleeve gastrectomy
In current surgical practice, the majority of the anastomoses is performed using a stapling device. Despite correct usage, staple line failure might still occur.
Concerning surgical stapling devices, the United States Food and Drug Administration (FDA) received reports of 22,804 malfunctions, 2,180 injuries, and 112 deaths from 1992 to July 1, 2001. These numbers included all types of linear and circular stapling devices as well as clip appliers. The majority of operations reported were gastrointestinal. Failure of stapling devices to function resulted in suture line separation or leak as the most common problem. When interpreting these data, it should be borne in mind that besides the fact that staplers are used very frequently, surgeons have to know the appropriate surgical techniques to inspect and verify staple line defects, and the techniques to employ if issues occur especially when performing complex surgery such as in this case of NOTES sleeve gastrectomy.
Thanks to the high skills of the surgeon, the procedure was completed using only one further port.
M Vix, J Marescaux
Surgical intervention
10 years ago
1119 views
11 likes
0 comments
06:35
Staple line failure during NOTES sleeve gastrectomy
In current surgical practice, the majority of the anastomoses is performed using a stapling device. Despite correct usage, staple line failure might still occur.
Concerning surgical stapling devices, the United States Food and Drug Administration (FDA) received reports of 22,804 malfunctions, 2,180 injuries, and 112 deaths from 1992 to July 1, 2001. These numbers included all types of linear and circular stapling devices as well as clip appliers. The majority of operations reported were gastrointestinal. Failure of stapling devices to function resulted in suture line separation or leak as the most common problem. When interpreting these data, it should be borne in mind that besides the fact that staplers are used very frequently, surgeons have to know the appropriate surgical techniques to inspect and verify staple line defects, and the techniques to employ if issues occur especially when performing complex surgery such as in this case of NOTES sleeve gastrectomy.
Thanks to the high skills of the surgeon, the procedure was completed using only one further port.