Department of Digestive Diseases, Obesity center, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France.
Hopital Prive des Peupliers, Service d'Endoscopie Interventionnelle, Paris, France.
Obes Surg. 2019 May;29(5):1697-1698. doi: 10.1007/s11695-019-03728-4.
Laparoscopic sleeve gastrectomy is the most common bariatric procedure worldwide, commonly performed using laparoscopic multiport. Feasibility and safety of single-port sleeve gastrectomy (SPSG) have been proved. We reported a standardized procedure describing the different steps as a reference for bariatric surgeons.
Two news concepts are necessary: "surgical corridor," surgeon working in a small intraperitoneal area is less disturbed by excess abdominal fat and liver hypertrophy; "parietal space" is the area in the abdominal wall through the instruments are introduced, it's important to preserve this. The patient was placed in a seated position and we utilized 2.5-3 cm skin incision in the umbilicus. Single trocar was placed; a flexible camera and double curve grasper are needed to decrease grasper conflict. Dissection of the stomach was obtained by 47 cm Thunderbeat (Olympus-Japan), the sleeve of the stomach was created over a 36F calibrator. A 60-mm roticulating XL staplers were used and beginning 4 cm proximal to the pylorus next to the gastro-pancreatic ligament and heading toward the left side of the gastro-esophageal junction. We utilized a linear staple line using 4 to 7 staples; hemostasis is controlled by bipolar coagulation.
Specimen was removed easily through the single-site trocar. Parietal defect is easily repaired. Operating time is 41 min. The patient was discharged at day 1 without naso-gastric tube or drainage. No complication.
Umbilical SPSG is nowadays a standardized procedure based on the surgical corridor and the parietal space. This is a safe and reproductive procedure applicable in most patients with massive obesity but necessitate learning curve.
腹腔镜袖状胃切除术是目前全球最常见的减重手术方式，通常采用腹腔镜多孔法进行。单端口袖状胃切除术（SPSG）的可行性和安全性已得到证实。我们报告了一种标准化的手术步骤，为减重外科医生提供参考。
需要引入两个新概念：“手术通道”，即外科医生在较小的腹腔区域工作，受腹部脂肪过多和肝肥大的干扰较小；“壁层间隙”是通过器械引入的腹壁区域，重要的是要保留这个区域。患者取坐位，脐部做 2.5-3cm 皮肤切口。单套管针置入，需要使用灵活的摄像头和双弯抓钳以减少抓钳冲突。使用 47cm 的 Thunderbeat（Olympus-Japan）进行胃的解剖，胃袖套在 36F 校准器上形成。使用 60mm 旋转式 XL 吻合器，从幽门近端 4cm 开始，紧邻胃胰韧带，朝向胃食管交界处左侧。我们使用 4 到 7 个吻合钉的直线吻合线；使用双极电凝控制止血。
标本很容易通过单端口套管针取出。壁层缺损很容易修复。手术时间为 41 分钟。患者在第 1 天出院，无需鼻胃管或引流。无并发症。
脐部 SPSG 目前是一种基于手术通道和壁层间隙的标准化手术程序。这是一种安全且可重复的手术方法，适用于大多数肥胖患者，但需要学习曲线。
