Right-sided upper abdomen single-incision laparoscopic gastric banding

Single-incision laparoscopic surgery (SILS) was recently implemented for performing gastric banding. However, concern exists regarding the safety of single-incision laparoscopic adjustable gastric banding (SILS-LAGB) compared to standard laparoscopy, and the operative technique is still evolving. We describe our preliminary experience of a new technique for SILS gastric banding based on a unique incision location, which allows a better view and improved dissection capability.

During a period of 6 months, ten patients underwent SILS-LAGB in our institution. The operative technique consisted of a 4-cm skin incision placed in the right upper quadrant (RUQ), starting from the midline and extending to the right, located above the mid-distance between the xiphoid and umbilicus. Through that incision, three trocars (two 5-mm trocars and one 15 mm) are inserted. The liver retraction was achieved through the additional subxiphoid skin puncture wound using Nathanson retractor.

Ten patients (eight females, two males) underwent SILS-LAGB. Mean age was 31.4 years (21-49) and mean BMI 40.9 kg/m(2) (39-44). In nine out of ten patients, the procedure was completed through the original skin incision. In one case, one additional trocar was inserted due to poor surgical field visualization. The operative time declined from 80 to 60 min along the learning curve. The mean hospital stay was 1.1 days (1-2). There was no mortality or morbidity.

The location of the incision in the RUQ enabled a better view of the retrogastric tunnel and facilitated the dissection, and therefore should be of comparable safety to a standard laparoscopic procedure.