Page 3 - Journal of World Association of Laparoscopic Surgeons

ORIGINAL ARTICLE
A Simple and Safe Technique in Extracting Specimen after

Sleeve Gastrectomy

2
1
Adem Yuksel , Murat Coskun
AbstrAct
Introduction: Today, minimally invasive surgery (laparoscopic, robotic) methods are becoming increasingly common. In the procedures in which
the resection was performed with a minimally invasive surgical method, specimen removal can be time-consuming and complicated. In this study,
we aimed to evaluate the results of laparoscopic sleeve gastrectomy specimens removed from a 12-mm trocar area without additional tools.
Materials and methods: Between January 2016 and December 2017, 129 patients underwent a laparoscopic sleeve gastrectomy for morbid
obesity. In all patients, the specimen was removed from the abdomen from a 12-mm trocar area without additional tools.
Results: The mean specimen removal time was 2.38 ± 1.9 minutes. During the follow-up period, no wound infection and trocar hernia were
observed in any patient.
Conclusion: The technique applied is minimally invasive, not time-consuming, and simple when compared to other techniques reported.
Keywords: Laparoscopic sleeve gastrectomy, Port hernia, Specimen extraction.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1357

IntroductIon 1 Department of Gastrointestinal Surgery, Kocaeli Derince Training and
Today, laparoscopic approach in gastrointestinal surgery is widely Research Hospital, Kocaeli, Turkey
used owing to its advantages. In the procedures that the resection 2 Department of General Surgery, Kocaeli Derince Training and
performed by the laparoscopic technique, different techniques Research Hospital, Kocaeli, Turkey
such as expanding trocar incision, mini laparotomy from different Corresponding Author: Adem Yuksel, Department of Gastrointestinal
regions, and removal from natural hole are used in the removal Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli,
1,2
of the specimen from the abdomen. These different incisions Turkey, Phone: +90 262 317 80 00, e-mail: ademyksel@yahoo.com
and methods may occasionally lead to the elimination of some How to cite this article: Yuksel A, Coskun M. A Simple and Safe
advantages (early postoperative recovery, decreased surgical site Technique in Extracting Specimen after Sleeve Gastrectomy. World J
infection, esthetic appearance, decreased risk of hernia, etc.) of Lap Surg 2019;12(1):1–4.

1
laparoscopic surgery. Source of support: Nil

Many different procedures in surgical treatment of morbid Conflict of interest: None

obesity can be performed with the laparoscopic technique. Among
these procedures, sleeve gastrectomy, in which the stomach
is resected in the vertical axis, has been applied in increasing All operations were performed by the same surgical team
3
frequency in recent years. The removal of the specimen after sleeve consisting of two persons. Pneumoperitoneum was created in such
gastrectomy can be time-consuming and complicated. There is a way to reach 12–14 mm Hg by entering the abdomen with the help
no standard approach on this and many different techniques are of a bladeless direct optical trocar (EndopathXcel; Ethicon Endo-
applied. Surgery Inc., Cincinnati, Ohio) from 19 cm below the xiphoid and
In our study, it was aimed to evaluate the results of our patient 4 cm lateral from the midline. The operation was performed with
group in which the sleeve gastrectomy specimen was removed 3 pieces of 5 mm and 2 pieces of 12 mm trocars, one of which was
from the 12-mm trocar area. the Nathanson retractor site (Fig. 1). All 12 mm trocars were bladeless
optic trocar. Starting from approximately 2 to 6 cm proximal of
pylorus, until the left diaphragmatic crura is revealed, the stomach
MAterIAls And Methods was released by the large curvature with the help of LigaSure
The study included patients who underwent laparoscopic sleeve (Valleylab, Boulder, CO) or harmonic scalpel (EthiconEndosurgery,
gastrectomy for morbid obesity at Kocaeli Derince Training and Cincinnati, OH). The stomach was decompressed with a nasogastric
Research Hospital between January 2016 and December 2017. or orogastric tube. The stomach was transected with the help of
The decision was made as a result of the evaluation of the a 36 F bougie-guided endoscopic stapler (Ethicon Endosurgery,
patients who were accepted according to the National Institutes Cincinnati, OH). Transection was completed with 5 or 6 staplers. The
4
of Health (NIH) consensus criteria by the team consisting of gastrectomy-performed stomach was evaluated for leakage with
surgery (gastrointestinal surgery, general surgery), endocrinology, 50–60 mL methylene blue. The resected stomach was held in the
psychiatry, gastroenterology, cardiology, chest diseases, sports caudal end with a laparoscopic grasper and was taken 2–3 cm in a
medicine specialist, and dietitian team. A prophylaxis with 2 g of 12-mm trocar parallel to the resection axis (Fig. 2). The specimen
ceftriaxone was applied to all patients before the operation. was removed from the abdomen with a trocar. The specimen was

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.