Single-Incision Transumbilical Laparoscopic Sleeve Gastrectomy with a Stomach Retractor in 20 Superobese Patients-a Video Vignette

Abstract

Background 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(2)). We aimed to introduce the technical details of SITU-LSG with a stomach retractor in superobese patients. Methods Twenty superobese patients with a range of BMI from 50.00 to 55.77 kg/m(2)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. Results 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gastrointestinal anastomosis staplers (Endo-GIAs) were used to resect the stomach, the resected gastric tissue was retracted by the stomach retractor.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. Conclusions The stomach retractor facilitates SITU-LSG. The combinatory procedure is safe, feasible, and effective in superobese patients.