Single-incision sleeve gastrectomy using a novel technique for liver retraction

Area of Science:

• Minimally Invasive Surgery
• Bariatric Surgery
• Surgical Innovation

Background:

• Laparoscopic sleeve gastrectomy is a popular bariatric procedure due to low morbidity and mortality.
• Traditional methods use 4-6 trocars, potentially increasing incisional morbidity.
• Single-access surgery aims to reduce incisional complications and improve cosmetic outcomes.

Purpose of the Study:

• To evaluate the safety and feasibility of single-incision laparoscopic sleeve gastrectomy (SIL-SG).
• To present a novel technique for internal liver retraction in SIL-SG.
• To assess the outcomes of SIL-SG in initial patient cases.

Main Methods:

• Analysis of 7 patients who underwent SIL-SG between March and May 2009.
• A single 4-cm left paramedian incision was utilized.
• Standard laparoscopic sleeve gastrectomy was performed using a 40 French bougie.

Main Results:

• All 7 patients were female with a mean age of 34 years and a mean preoperative BMI of 49 kg/m².
• No intraoperative complications occurred; mean operative time was 103 minutes with minimal blood loss.
• Patients were discharged on postoperative day 2 and remained complication-free at follow-up (3.1 ± 0.7 months).

Conclusions:

• Single-incision laparoscopic sleeve gastrectomy is safe and feasible.
• The novel internal liver retraction technique provides adequate exposure and is reproducible.
• Further development of specialized instrumentation is needed for wider adoption of this technique.