Modified single-incision laparoscopic adjustable gastric band

Abstract

Introduction

This video describes a modified single-incision laparoscopic approach for adjustable gastric band placement.

Method

The patient was a 28-year-old female with a BMI of 48.75 with no prior surgery but with numerous comorbidities. With the patient placed in a split-leg position and in steep reverse Trendelenburg, a 12-mm optical trocar is placed 12 cm distal to the xiphoid process in the left paramedian location. A Nathanson liver retractor is placed through a midepigastric 5-mm incision. Two 5-mm low-profile trocars are placed next to the 12-mm trocar through separate incisions (this maintains stability of each cannula) and a 5-mm 45° laparoscope is used. Using an automated suturing device, a stay suture is placed high on the fundus and externalized for retraction. An articulating band passer dissects the phrenogastric attachments at the angle of His. The 12-mm port is removed and the gastric band is inserted. The GE junction fat pad is excised and the Pars Flaccida membrane is divided using conventional instruments. A second traction suture is placed to retract the lesser curve fat and right crus fat pad. A peritoneal bite is also taken in the left lateral subcostal area such that when this suture is externalized, it acts as a pulley. An articulating 5-mm grasper is used to develop the retrogastric tunnel. Then the band is fed into position and its buckle is locked. Three interrupted sutures are placed to create an anterior gastric plication and a fourth antislippage suture is placed below the band along the lesser curve. The band tubing is externalized and the port is implanted by joining the three working trocar incisions into a single 4.5-cm incision.

Results

The patient did well postoperatively with no complications.

Conclusions

A modified single incision approach for laparoscopic gastric band placement is feasible and provides patients with improved cosmesis.

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Disclosures

Dr. Daniel Scott has a licensing agreement with Ethicon Endosurgery regarding Magnetic Anchoring and Guidance Systems (MAGS). He also has research grants with Ethicon Endosurgery. Dr. Scott is a speaker for Covidien and also has research grants with this company. Dr. Scott is a speaker for Allergan. Dr. Scott has research and equipment grants with Storz. Dr. Scott is a consultant for Accelerated Technologies Incorporated. Dr. Scott receives honoraria and reimbursed travel for any activities that may involve any role previously described. Dr. Scott has no stock ownership, equity interests, patent-licensing arrangements, etc., that might pose a conflict of interest in connection with the submitted article. Dr. Scott’s detailed disclosures have not influenced in any way, shape, or form this scientific work and its publication.

Dr. Esteban Varela is a research consultant for Ethicon Endosurgery. He receives honoraria and reimbursed travel for any activities that may involve this consulting role. Dr. Varela has no stock ownership, equity interests, patent-licensing arrangements, etc., that might pose a conflict of interest in connection with the submitted article. Dr. Varela’s detailed disclosures have not influenced in any way, shape, or form this scientific work and its publication.

Dr. Antonio Castellvi has no conflicts of interest or financial ties to disclose.

Dr. Homero Rivas is a consultant and speaker for Covidien. He receives honoraria and reimbursed travel for any activities that may involve either role previously described. Dr. Rivas has no stock ownership, equity interests, patent-licensing arrangements, etc., that might pose a conflict of interest in connection with the submitted article. Dr. Rivas detailed disclosures have not influenced in any way, shape, or form this scientific work and its publication.

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Correspondence to Daniel J. Scott or Antonio O. Castellvi.

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Scott, D.J., Castellvi, A.O., Varela, J.E. et al. Modified single-incision laparoscopic adjustable gastric band. Surg Endosc 24, 2314–2315 (2010). https://doi.org/10.1007/s00464-010-0910-8

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Keywords

  • Laparoendoscopic single-site surgery
  • Bariatric
  • Obesity
  • Adjustable gastric band
  • Laparoscopy