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Single Incision Bariatric Surgery. Ninh T. Nguyen, MD, FACS University of California, Irvine Medical Center, Orange, CA. Disclosures. Covidien Grant/speaker Gore Speaker Surgiquest Consultant Reshape Research Ethicon Speaker. Rationale for Single Incision Bariatric.

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single incision bariatric surgery

Single Incision Bariatric Surgery

Ninh T. Nguyen, MD, FACS

University of California, Irvine

Medical Center, Orange, CA

disclosures
Disclosures
  • Covidien Grant/speaker
  • Gore Speaker
  • Surgiquest Consultant
  • Reshape Research
  • Ethicon Speaker
rationale for single incision bariatric
Rationale for Single Incision Bariatric
  • Band – need a 3.5 cm incision to place subQ port
  • Sleeve – need to remove gastric specimen
  • Bypass – no role
acronym
Acronym
  • Single Port Access (SPA)
  • Natural Orifice Transumbilical Surgery (NOTUS)
  • Single Incision Laparoscopic Surgery (SILS)
  • Single Laparoscopic Incision Transabdominal (SLIT) surgery
  • Laparosendoscopic Single Site Surgery (LESS)
  • Strategic Laparoscopy for Improved Cosmesis (SLIC)
philosophy of slic
Philosophy of SLIC
  • Strategic use of anatomic sites that will minimize visible postoperative scars - Umbilicus- Suprapubic region
  • Not new philosophy (plastic, ENT, GYN)
  • Still laparoscopy (maintain triangulation)
balanced strategy to single incision bariatric surgery
Balanced Strategy to Single Incision Bariatric Surgery
  • - Technical difficulty
  • Compromising safety
  • Prolong OR time

Improved cosmesis

hurdles from laparoscopy to sils
Hurdles from Laparoscopy to SILS
  • Lack triangulation
  • Use of 5 mm scope
  • “Fighting” of instrumentation
evolution of sils to slic
Evolution of SILS to SLIC
  • Better triangulation
  • Less “fighting” of instrumentation
notus appendectomy
NOTUS Appendectomy

NOTUS Cecectomy.mpg

single incision gastric band
Single Incision Gastric Band

Lap Band SLIT band realize.mpg

evolution of single incision gastric banding
Evolution of Single Incision Gastric Banding
  • Single incision (4-4.5 cm) between umbilicus and xyphoid process
  • Transition to single incision (3.2 cm) and three 5 mm trocars within umbilicus
trocar position for slic gastric banding
Trocar Position for SLIC Gastric Banding

Lap band SLIT realize fast.wmv

relative contraindications of slic
Relative Contraindications of SLIC
  • BMI > 50
  • Need to perform other procedures (hiatal hernia repair)
  • Hx of prior bariatric or gastric surgery
conclusions
Conclusions
  • In a selected group of patient, SLIC bariatric operations are feasible
  • Safe – no major complications
  • Reproducible – low conversion rate to laparoscopy
  • Outcomes - comparable between SLIC vs. laparoscopic sleeve & band without prolonging the operative time
  • Cost – comparable with utilization of mostly conventional trocars, instrument, and scope
single incision bariatric surgery1

Single Incision Bariatric Surgery

Ninh T. Nguyen, MD, FACS

University of California, Irvine

Medical Center, Orange, CA

strategic laparoscopy for improved cosmesis slic bariatric surgery

Strategic Laparoscopy for Improved Cosmesis (SLIC) – Bariatric Surgery

Ninh T. Nguyen, MD, FACS

University of California, Irvine

Medical Center, Orange, CA

we re making progress
We’re Making Progress

Come on! It can‘t go

wrong every time...

philosophy of slic1
Philosophy of SLIC
  • Transition most or all laparoscopic trocars to strategic location that minimize operative scar- Umbilicus- Suprapubic region
  • One visible 5 mm incision
spectrum of invasiveness
Spectrum of Invasiveness

Open

Laparoscopic

Single Incision