Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Tieyi Road, Haidian District, Beijing, 100038, China.
Obes Surg. 2020 Dec;30(12):5179-5181. doi: 10.1007/s11695-020-04995-2. Epub 2020 Sep 29.
The safety and feasibility of single-incision transumbilical laparoscopic sleeve gastrectomy (SITU-LSG) have been proven in obese patients, with great aesthetics. However, it is not performed in superobese patients (BMI ≥ 50 kg/m). We aimed to introduce the technical details of SITU-LSG with a stomach retractor in superobese patients.
Twenty superobese patients with a range of BMI from 50.00 to 55.77 kg/m underwent stomach retractor-assisted SITU-LSG. An intraoperative laparoscopic video has been anonymized and edited to demonstrate the course of the operation on superobese patient.
The stomach retractor has a mini grasper end, which can be opened with external force and closed without force, and it was inserted from a 1.5-mm incision at the left upper abdomen. A Kirschner needle (K-needle) was inserted into the right diaphragmatic crura to retract the liver so that the pylorus and fundus of the stomach could be exposed adequately. Traction on the omentum majus and insertion of 34 Fr. Bougie tube were achieved with the aid of the stomach retractor. When endovascular gastrointestinal anastomosis staplers (Endo-GIAs) were used to resect the stomach, the resected gastric tissue was retracted by the stomach retractor. During the reinforce of staple line, the stomach retractor was used to press the proximal end of staple line into the purse string and immobilize the gastric sleeve. After surgery, the patients underwent uneventful postoperative courses.
The stomach retractor facilitates SITU-LSG. The combinatory procedure is safe, feasible, and effective in superobese patients.
经证实，单切口经脐腹腔镜袖状胃切除术（SITU-LSG）在肥胖患者中是安全且可行的，且具有良好的美观效果。然而，对于超级肥胖患者（BMI≥50kg/m²），目前还不能进行 SITU-LSG。我们旨在介绍一种在超级肥胖患者中使用胃牵开器的 SITU-LSG 技术细节。
20 例 BMI 范围为 50.00-55.77kg/m²的超级肥胖患者接受了胃牵开器辅助的 SITU-LSG。术中腹腔镜视频经过匿名处理和编辑，以展示超级肥胖患者手术过程。
胃牵开器具有迷你抓钳端，可通过外力张开，无需用力即可闭合，从左上腹部 1.5mm 切口插入。将克氏针（K 针）插入右膈肌脚以牵拉肝脏，使胃的幽门和底部充分暴露。借助胃牵开器，可以对大网膜进行牵引，并插入 34Fr. 引导管。当使用血管内胃肠吻合吻合器（Endo-GIAs）切除胃时，胃牵开器将切除的胃组织牵拉。在加固吻合线时，胃牵开器用于将吻合线的近端压入荷包缝线并固定胃袖。手术后，患者术后恢复顺利。
胃牵开器有助于进行 SITU-LSG。联合手术在超级肥胖患者中是安全、可行且有效的。
