Ahluwalia Jasmeet Singh, Chang Po-Chih, Yeh Lee-Ren, Lin Hung-Yu, Chi Shu-Ching, Huang Chih-Kun
Bariatric and Metabolic International (BMI) Surgery Center, E-Da Hospital, 1, E-Da Road, Kaohsiung City, 82445, Taiwan.
Obes Surg. 2014 Sep;24(9):1585. doi: 10.1007/s11695-014-1318-7.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the gold standard procedure in bariatric surgery but requires 4-7 ports. We have reported the first single incision transumbilical Roux-en-Y gastric bypass (SITU-RYGB) in 2009 (Huang et al. Obes Surg 19:1711-1715, 2009). Over the years, we have standardized our procedure and this video highlights the same by showing both inside and outside views. This video was shot from outside as well to give better understanding of the procedure. A 4.5-cm incision was made according to the contour of umbilicus and space was created over the sheath to give more range of movement to the instruments. The procedure was carried out using conventional laparoscopic instruments and replicating all the steps of the procedure under adequate visualization. Picture-in-picture effect has been used at important steps. Findings were recorded. The procedure took 96 min without any intraoperative complication. Blood loss was 20 cc. The incision was hardly noticeable at the end of the procedure. We have previously compared our results of SITU-RYGB with that of our multiport RYGB where operative time was longer for SITU-RYGB versus multiport technique (101.1 vs. 81.1 min, P = 0.001) (Huang et al. Surg Obes Relat Dis 8:201-207, 2012). No difference in complications was observed. The SITU-LRYGB patients reported greater satisfaction related to scarring than those who had undergone five-port surgery (P = 0.005). Difference in analgesia requirement was not statistically significant. There was no mortality. Compared with conventional LRYGB, SITU-RYGB resulted in acceptable complications, the same recovery, comparative weight loss, and better patient satisfaction related to scarring.
腹腔镜Roux-en-Y胃旁路术（LRYGB）被认为是减肥手术的金标准术式，但需要4至7个切口。我们在2009年报道了首例单切口经脐Roux-en-Y胃旁路术（SITU-RYGB）（Huang等人，《肥胖外科》，2009年，第19卷，第1711 - 1715页）。多年来，我们已将该手术标准化，此视频通过展示内部和外部视图突出了这一点。该视频也从外部拍摄，以便更好地理解手术过程。根据脐部轮廓做一个4.5厘米的切口，并在筋膜上制造空间，以使器械有更大的活动范围。手术使用传统腹腔镜器械进行，并在充分可视化的情况下复制手术的所有步骤。在重要步骤使用了画中画效果。记录了手术结果。手术用时96分钟，无任何术中并发症。失血20毫升。手术结束时切口几乎难以察觉。我们之前比较了SITU-RYGB与多切口RYGB的结果，其中SITU-RYGB的手术时间比多切口技术更长（101.1对81.1分钟，P = 0.001）（Huang等人，《肥胖与相关疾病外科》，2012年，第8卷，第201 - 207页）。未观察到并发症有差异。SITU-LRYGB患者对瘢痕的满意度高于接受五切口手术的患者（P = 0.005）。镇痛需求的差异无统计学意义。无死亡病例。与传统LRYGB相比，SITU-RYGB导致可接受的并发症、相同的恢复情况、相当的体重减轻以及与瘢痕相关的更好的患者满意度。
