Integrating minimally invasive bariatric surgery with lessons from gastric cancer surgery

Laparoscopic procedures in bariatric surgery are evolving to enhance cosmetic outcomes and minimize postoperative complications. This study demonstrates the results of bariatric surgery achieved through the application of surgical techniques derived from gastric cancer surgery. Several surgical techniques from gastric cancer surgery were implemented in bariatric surgery, including: (1) V-shaped liver retraction, (2) Reduced port surgery, (3) Intraoperative endoscopy and (4) Multi-degree-of-freedom articulating device. A single surgeon, with experience in over 1000 gastric cancer surgeries, performed consecutive bariatric surgeries starting from the initial case. The study analyzed short-term results, including operation details, postoperative complications, outcomes of weight loss, and the learning curve. A total 94 consecutive laparoscopic sleeve gastrectomy cases were performed from 2019 to 2022. The mean age of 94 patients was 35.9 ± 9.7 years, with 58 (61.7%) being female. The mean body mass index (BMI) was 40.9 ± 6.2. Type 2 diabetes was prevalent in 46.8% of the patients. On average, 3.3 ± 0.5 trocars were used per surgery. The mean estimated blood loss and hospital stay after surgery were 20.1 ± 36.3 cc and 3.3 ± 0.6 days, respectively. There were no complications reported for postoperative leakage, bleeding, or passage disturbance, and no mortality occurred. At 12 months, the mean percentage total weight loss (%TWL) and excess BMI loss (%EBMIL) were 28.5% and 79.7%, respectively. The mean operation times was 109.5 ± 27.4 min, with a plateau observed at around the 30th case. Bariatric surgery can be effectively performed by a gastric cancer expert surgeon using techniques derived from gastric cancer surgery.