The Use of Single Incision Laparoscopy in Bariatric Surgery
Without a doubt, bariatric surgery is one of the greatest advancements in weight loss
, and as the surgery has evolved, surgeons have created more non-invasive methods to improve its effectiveness and increase patient comfort during the process. Most notably among these developments is laparoscopic surgery, where instead of a long incision across the abdomen, five smaller incisions are made and the surgeon uses a laparoscope, or small camera, to see while performing the procedure. Studies have shown that bariatric surgery patients who undergo a laparoscopic approach do better in their recovery than those who have open incisions during surgery.
Yet, while laparoscopic bariatric surgery is certainly remarkable, a new technique allows bariatric surgery to be performed using a single, relatively tiny laparoscopic incision instead of five. Called Single-Incision Laparoscopic Surgery, or SILS for short, the technique uses only one incision to minimize recovery time, patient discomfort and surgical scarring.
How Is SILS Different from Older Methods?
SILS is the latest advancement in bariatric surgery. It improves upon laparoscopic silicone banding procedures like the LAP-BAND and procedures like the sleeve gastrectomy. Before defining what SILS is, it helps to know a little background about bariatric surgery.
When bariatric surgery first emerged and even at some clinics today, it is fairly common to use a single, long, "open" incision along the abdomen so the surgeon can easily maneuver when altering the stomach. This technique has a few disadvantages, namely that the long incision makes the recovery lengthier and more painful. The next innovation was performing bariatric surgery by making several smaller incisions and using a laparoscope to see inside the patient and visualize the surgical area. The SILS method also uses a laparoscope, but consolidates the incisions into just one incision that is located inside the umbilicus (belly button). Advantages over traditional laparoscopic surgery include increased patient comfort, decreased scarring and a faster recovery.
Bariatric Procedures Performed Using SILS
One of the most popular laparoscopic bariatric procedures is the
LAP-BAND, which an increasing number of bariatric surgeons are performing with the SILS method. LAP-BAND is a surgery which, as the name suggests, places a flexible silicone band around the upper part of the stomach to produce a small "pouch" that restricts the patient's food-intake. LAP-BAND is popular in part because the procedure is reversible, allowing patients to return to more normal (but still healthier) eating habits once they have lost their excess weight.
Another bariatric procedure that can benefit from use of the SILS technique is the Vertical Sleeve Gastrectomy, a restrictive procedure that removes about 85% of the stomach to limit food intake. The surgery helps reduce food cravings and appetite because the portion of the stomach that the surgeon removes is responsible for secreting the hormone that signals hunger to the brain. The procedure is often more desirable than gastric bypass surgery because it doesn't produce vitamin deficiencies or other complications that "bypassing" the gastric system can produce. And, with the added benefits of laparoscopic surgery, the sleeve gastrectomy can be performed on severely obese patients with less discomfort and a quicker recovery.
What Are the Challenges?
While SILS offers many benefits, it is in many respects a more challenging technique than the laparoscopic technique using multiple incisions. The largest difficulty is that it is more technically difficult to work with only one incision point. Additionally, to meet cosmetic concerns, placing the incision in the belly button increases the distance between the entry point and the area being worked on. To compensate for these challenges, surgeons may need to re-learn laparoscopic techniques to work from a single point of access. These concerns are being addressed through newer laparoscopic tools and a great deal of surgical practice.
Because of these technical challenges, it is important to choose a surgeon who has been thoroughly trained and who has performed a significant number of bariatric procedures using the SILS technique. Not all patients considering weight loss surgery may be candidates for SILS, so speaking with a doctor about options for
bariatric surgery in Southern California or elsewhere in the U.S. is an important first step.
The Use of Single Incision Laparoscopy in Bariatric Surgery
By: David Thoman
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