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Kara YB, Buluc H, Elgezen M, Yildiz E, Yardimci S. A Simple Way to Estimate a Difficult Sleeve Gastrectomy Prior to Operating. Obes Surg 2024; 34:1159-1167. [PMID: 38374321 PMCID: PMC11026237 DOI: 10.1007/s11695-024-07093-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Today, bariatric procedures are common. These surgeries' difficulties are classified as patient- or surgical team-related and are estimated by body mass index (BMI). More efficient methods are needed to help surgeons. This study evaluated the effect of measuring patients' subcutaneous fat tissue thickness (SFT) and umbilicus-xiphoid (DXU) to anticipate surgical difficulties. MATERIAL AND METHODS This was a prospective retrospective data analysis study. Laparoscopic sleeve gastrectomy patients seen between May and October 2022 were included in the analysis and divided into three groups, according to a surgeon's assessment. All patients' SFT, DXU, rectus muscle thickness, total fat tissue amount (TFT), and operational time were recorded prospectively and analyzed. RESULTS In all, 151 patients were included in the study; of these, 124 (82.1%) were women and 27 (17.9%) were men. Their mean BMI value was 41.1 ± 6.2. Based on expert's opinion, we classified three groups: easy (n = 123, 81.5%), intermediate (n = 22, 14.6%), or difficult (n = 6, 4%). When the easy group was compared to the intermediate/difficult groups, we found that intermediate/difficult groups' SFT values were statistically significantly higher than the easy group (p = 0.000). Also, the intermediate/difficult group's TFT value was statistically significantly higher than the easy group (p = 0.000). We found no statistically significant differences between groups' DXU and rectus muscle thickness. CONCLUSION This is the first study to anticipate sleeve gastrectomy difficulty using SFT and TFT. This is an easy technique to apply and no additional costs. Anticipating difficulties based on these criteria can ensure necessary preparations are made and help avoid complications.
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Affiliation(s)
- Yalcin Burak Kara
- General Surgery Department, Bahcesehir University VM Medical Park Pendik Hospital, Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No: 9, Pendik, 34899, Istanbul, Turkey.
| | - Halil Buluc
- Department of Anestesiology, VM Medical Park Pendik Hospital, Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No: 9, Pendik, 34899, Istanbul, Turkey
| | - Mehmet Elgezen
- Department of Radiology, VM Medical Park Pendik Hospital, Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No: 9, Pendik, 34899, Istanbul, Turkey
| | - Edanur Yildiz
- School of Medicine, Bahcesehir University, Sahrayı Cedit, Batman Sk., No: 66, Kadıkoy, 34734, Istanbul, Turkey
| | - Samet Yardimci
- General Surgery Department, Istinye University VM Medical Park Pendik Hospital, Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No: 9, Pendik, 34899, Istanbul, Turkey
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Afsar S, Usta CS, Usta A, Lafcı D, Gunay I, Karabudak CB. Teres lift-up technique: a retrospective comparative study for an alternative route for laparoscopic entry in gynecologic and oncologic surgery. Arch Gynecol Obstet 2023; 308:1549-1554. [PMID: 37650933 DOI: 10.1007/s00404-023-07191-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Laparoscopic surgery is the favored method for the surgical treatment of gynecologic diseases and malignancies. We have defined an anatomic landmark-based, easy-to-perform, and an alternative way of open laparoscopic entry technique named the ligamentum teres lift-up technique (TLU) that can be used in obese or normal-weight women to tackle the risks of the closed laparoscopic entry technique, namely, Veress needle entry (VNE). STUDY DESIGN In this retrospective comparative study, the participants were equally distributed to either the TLU group (n = 36) or the VNE group (n = 36) in a 1:1 ratio. The participants were stratified according to their BMI as follows: BMI between 20-25 kg/m2 (average weight), 25-30 kg/m2 (overweight), 30-35 kg/m2 (class I obesity), and 35-40 kg/m2 (class II obesity). Both laparoscopic access techniques were compared according to the entry time, vascular or visceral injuries, insufflation failures, trocar-related complications, and omental damage. RESULTS The TLU group had a considerably shorter entry time than the VNE group (74.43 ± 21.45 s versus 192.73 ± 37.93 s; p < 0.001). Only one failed insufflation occurred in the VNE group (p = 0.32); however, that case was successfully insufflated with the TLU technique. Only one intestinal injury was seen in the VNE group, encountered during trocar site closure (p = 0.32). The subgroup analyses of the TLU and VNE groups based on BMI strata revealed a continuation of the statistical significance of entry time between BMI-matched groups. CONCLUSION The current study reveals that the new alternative TLU technique supplies an alternative, validated, and rapid access to the abdominal cavity in normal-weight and obese women. This new approach offers an easy-to-teach and easy-to-perform technique for surgical mentors and residents in gynecologic and oncologic surgeries.
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Affiliation(s)
- Selim Afsar
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Balıkesir University, Cagis Yerleskesi, Bigadic yolu 17 km, 10145, Balikesir, Turkey.
| | - Ceyda Sancaklı Usta
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Balıkesir University, Cagis Yerleskesi, Bigadic yolu 17 km, 10145, Balikesir, Turkey
| | - Akın Usta
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Balıkesir University, Cagis Yerleskesi, Bigadic yolu 17 km, 10145, Balikesir, Turkey
| | - Duygu Lafcı
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Balıkesir University, Cagis Yerleskesi, Bigadic yolu 17 km, 10145, Balikesir, Turkey
| | - Izel Gunay
- Deptment of Obstetrics and Gynecology, Health Sciences University, Istanbul, Turkey
| | - Can Berk Karabudak
- Deptment of Obstetrics and Gynecology, Health Sciences University, Istanbul, Turkey
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Shinde P, Gajjar A, Karvande R. Modified optical port entry site for laparoscopic cholecystectomy: Our experience. POLISH JOURNAL OF SURGERY 2023; 96:23-25. [PMID: 38348983 DOI: 10.5604/01.3001.0053.9350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
<b><br>Introduction:</b> The four-port laparoscopic cholecystectomy is a recognized entity in the surgical management of gallstone disease. We report our experience and feasibility of optical port entry site modification.</br> <b><br>Material and Methods:</b> To assess the feasibility and safety of laparoscopic cholecystectomy with a different port placement, we undertook a prospective study with 60 patients at Seth GSMC and KEM Hospital, India between Jan 2022 and July 2022. Our study offered the benefit of a flexible optical port entry site, using a 5 mm optical trocar instead of the conventional 10 mm trocar. A single surgeon did all the cases and definite criteria of simple cases of gallstone disease patterned on clinical and radiological grounds.</br> <b><br>Results:</b> 60 cases of gallstone disease were subjected to the new technique of laparoscopic cholecystectomy over seven months. 39 cases were females and 21 were males. The age range of our patients was between 20 and 55 years with a median age of 39 years. Mean Body mass index 30 (range 25 - 37). The mean operative time was 30 min (range 15 - 45 min) and a follow-up period ranged from 10 to 14 months. No cases were converted to open. We did not encounter any untoward mishaps during surgery.</br> <b><br>Discussion:</b> Our modification of the optical port placement and size received good results and patient satisfaction. Moreover, the placement of the port at a site further from the midline and umbilicus decreases the risk of development of trocar site incisional hernia.</br>.
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Affiliation(s)
- Pravin Shinde
- Department of General Surgery, Seth GSMC and KEM Hospital Parel, Mumbai, India
| | | | - Rajiv Karvande
- Department of General Surgery, Seth GSMC and KEM Hospital Parel, Mumbai, India
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Amiki M, Ishiyama Y, Harada T, Mochizuki I, Tomizawa Y, Ito S, Oneyama M, Hara Y, Narita K, Tachimori Y, Goto M, Sekikawa K, Kuba M. Initial entry via the left upper quadrant with an optical trocar in laparoscopic bariatric surgery. Asian J Endosc Surg 2022; 15:463-466. [PMID: 34994085 DOI: 10.1111/ases.13019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Laparoscopic bariatric surgery (BS) is not readily performed in Japan. To facilitate safe initial access to the abdominal cavity, we insert an optical viewing trocar at a unique site in the left upper quadrant (LUQ). Herein, we describe the technique, its advantages, and outcomes. MATERIALS AND SURGICAL TECHNIQUE Briefly, the optical trocar is inserted just below the left subcostal margin, 8 cm from the midline. On insertion, layers of the abdominal wall are visualized on the monitor. Depending on the angle of insertion, five, seven, or eight layers are seen. DISCUSSION In assessing our initial entry technique, used in 21 obese patients undergoing laparoscopic sleeve gastrectomy, we found median insertion time to be 25 seconds. There were no related complications. In nearly all (20/21) patients, the abdominal wall was visualized as seven layers: subcutaneous fat, anterior rectus sheath, rectus abdominis muscle, posterior rectus sheath, transverse abdominis muscle, transversalis fascia, and peritoneum. Understanding the layers of the abdominal wall visualized during optical trocar insertion in the LUQ will provide for safe and rapid initial entry in patients undergoing laparoscopic BS and can further the widespread acceptance of laparoscopic BS.
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Affiliation(s)
| | | | | | | | | | - Shingo Ito
- Kawasaki Saiwai Hospital, Kawasaki City, Japan
| | | | | | | | | | - Manabu Goto
- Kawasaki Saiwai Hospital, Kawasaki City, Japan
| | | | - Motoko Kuba
- AOI Universal Hospital, Kawasaki City, Japan
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Shahabi S, Carbajo M, Nimeri A, Kermansaravi M, Davarpanah Jazi AH, Pazouki A, Mahawar K. Factors that make Bariatric Surgery Technically Challenging: A Survey of 370 Bariatric Surgeons. World J Surg 2021; 45:2521-2528. [PMID: 33934198 DOI: 10.1007/s00268-021-06139-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is no published data on the factors bariatric surgeons think make bariatric surgery challenging. This study aimed to identify factors that bariatric surgeons feel and increase the technical complexity of bariatric surgery. METHODS Bariatric surgeons from around the world were invited to participate in a questionnaire-based survey on Survey Monkey®. An Average Weighted Score was calculated for each factor. A score of < 1.0 meant that the factor was perceived to make surgery technically easier. RESULTS Three hundred seventy bariatric and metabolic surgeons from 59 countries completed the survey. The top 10 factors that our respondents felt were most important for determining the technical difficulty of a procedure were inappropriate trocar placement (AWS 3.44), BMI above 60 (AWS 3.41), open bariatric surgery (AWS 3.26), less experienced bariatric anesthetist (AWS 3.18), liver cirrhosis (AWS 3), large liver (AWS 2.99), less experienced bariatric assistant (AWS 2.97), lower surgeon total bariatric surgery volume (AWS 2.95), lower surgeon specific procedure volume (AWS 2.85) and previous laparotomy (AWS 2.83), respectively. Respondents also felt that the younger patients (AWS 0.78), dedicated operating team (AWS 0.67), BMI less than 35 (AWS 0.54), and French position (AWS 0.45) actually make the surgery easier. CONCLUSION This survey is the first attempt to understand the factors which make bariatric surgery more difficult. Knowing the factors made the operation more challenging, led to better scheduling the potentially difficult patients to reduce the complications.
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Affiliation(s)
- Shahab Shahabi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Miguel Carbajo
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Calle Estacion, Valladolid, Spain
| | - Abdelrahman Nimeri
- Bariatric Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Davarpanah Jazi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran. .,Department of Surgery, Shariati Hospital, Isfahan, Iran.
| | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Kamal Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
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Lamoshi A, Chernoguz A, Harmon CM, Helmrath M. Complications of bariatric surgery in adolescents. Semin Pediatr Surg 2020; 29:150888. [PMID: 32238287 DOI: 10.1016/j.sempedsurg.2020.150888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Over the past decade, outcomes data have demonstrated the benefit of bariatric surgery in achieving both sustained weight loss and reversal of co-morbidities. Comparing these data to contemporary known risks of adolescent bariatric surgery informs the patients and providers considering bariatric procedures and provides insight into potential ways to reduce and manage complications. The goal of this article is to review the common surgical and postoperative complications following bariatric procedures and discuss approaches to improve their safety. A systematic review identifying bariatric surgery complications in adolescents was conducted. The review focused on the data relevant to adolescent bariatric surgery. However, when necessary, adult studies were used to address the gaps in available pediatric information. The data pertaining to the intraoperative, short term, and long term surgically related and nutritional related complications show that complication are declining with increasing experience. Specific recommendations and strategies to avoid major complications of bariatric surgery in adolescents are offered.
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Affiliation(s)
- Abdulrouf Lamoshi
- Oishei Children's Hospital, Pediatric Surgery Department, Buffalo, NY, USA
| | - Artur Chernoguz
- Floating Hospital for Children at Tufts Medical Center, Pediatric Surgery Division, Boston, MA, USA
| | - Carroll M Harmon
- Oishei Children's Hospital, Pediatric Surgery Department, Buffalo, NY, USA
| | - Michael Helmrath
- Cincinnati Children's Hospital Medical Center, Pediatric Surgery Division, Cincinnati, OH, USA.
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Glatz T, Horvath P, Lang SA, Archid R, Nadiradze G. Staging laparoscopy and Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for peritoneal metastasis: safe access to the abdomen. Pleura Peritoneum 2019; 4:20190004. [PMID: 31198854 PMCID: PMC6545875 DOI: 10.1515/pp-2019-0004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 12/19/2022] Open
Abstract
Background Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is an innovative drug delivery technique. Most common indication is palliative therapy of peritoneal metastasis of gastrointestinal and gynecological origin in the salvage situation. Access to the abdomen is the critical step of the procedure, since most patients had previous surgery. Potential pitfalls include non-access because of adhesions, bowel access lesions and postoperative subcutaneous toxic emphysema. Methods We propose a technique, the “finger-access technique” that might prevent largely these pitfalls. A minilaparotomy of 3 cm is performed in the midline, a finger introduced into the abdomen and a 5-mm double-balloon trocar (no Hasson trocar) is placed under finger protection at some distance of the first incision. The fascia of the minilaparotomy, not the skin, is then closed. The abdomen is insufflated with CO2 and tightness is controlled with saline solution in the minilaparotomy. A second 10–12 mm trocar is then introduced under videoscopic control. The first trocar is then visualized through the second one to exclude a bowel lesion during first access. Results and conclusions In our hands, this access technique has shown to be safe and effective.
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Affiliation(s)
- Torben Glatz
- Department of General and Visceral Surgery, University of Freiburg, Freiburg, Germany
| | - Philipp Horvath
- Department of General and Transplant Surgery and National Center for Pleura and Peritoneum, University of Tübingen, Tübingen, Germany
| | - Sven A Lang
- Department of General and Visceral Surgery, University of Freiburg, Freiburg, Germany
| | - Rami Archid
- Department of General and Transplant Surgery and National Center for Pleura and Peritoneum, University of Tübingen, Tübingen, Germany
| | - Giorgi Nadiradze
- Department of General and Transplant Surgery and National Center for Pleura and Peritoneum, University of Tübingen, Tübingen, Germany
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