Elastic Intra-corporeal Retractor for Bariatric and Upper Gastrointestinal Surgery.

INTRODUCTION: In minimally invasive upper gastrointestinal and bariatric surgery, proper organ retraction, especially liver retraction, is essential to achieve better per-operative precision and safety. Most currently used methods require specific material which might not be available in all hospitals. We introduce an easily reproducible low-cost trocar-less elastic intra-corporeal retractor (ICR). MATERIALS AND METHODS: ICR was created then used in two institutions where around 500 upper gastrointestinal and bariatric procedures are jointly performed yearly. Its design and application require an elastic rubber band, three staples, and a needle holder. For liver retraction, ICR is anchored to the right diaphragmatic crus and the anterior abdominal wall, creating a triangular shaped retractor. RESULTS: ICR requires around 2-3 min for application and can be easily repositioned for adequate exposure. Its trocar-less and intra-corporeal characteristics offer the advantage of decreasing the risk of bleeding, infection, and liver injury accompanying additional trocars, transcutaneous punctures and conventional retractors. CONCLUSION: ICR is a safe, effective, inexpensive, and easily reproducible intra-corporeal organ retractor which can be used in both laparoscopic and robotic bariatric surgery.

Safety and Efficacy of Trocar Port-Site Closure Using a Biological Plug Closure in Laparoscopic Bariatric Surgery: a Prospective Study.

PURPOSE: Port-site trocar closure is a challenging procedure in laparoscopic surgeries, especially in morbidly obese patients, and complications (herniation, bleeding, pain, and nerve trapping) have potentially severe consequences. This paper provides an overview of existing techniques of suturing and closure in intra-abdominal laparoscopic surgery, outlines the complications associated with port-site closure, and presents a novel technique designed to address those problems by using a sterile absorbable gelatin sponge with strong hemostatic properties (Cutanplast® Plug). MATERIALS AND METHODS: In this prospective study, 83 successive obese patients undergoing laparoscopic bariatric surgery (sleeve gastrectomy, sleeve plication, gastric bypass), using a standardized skin incision for trocar insertion, had port-site closure using the Cutanplast plug procedure (n = 42) or conventional suturing techniques (n = 41). RESULTS: The incidence of early complications was lower in the Cutanplast group; no patients had infections compared with 9.8% of Controls (p = 0.055) and no bleeding, ecchymosis, erythema, or redness occurred. Late complications during 2 years of follow-up were significantly lower in the Cutanplast group (0 vs. 7 hernias, p = 0.005). Most patients in the Cutanplast group required only 1-2 procedures (78.6% vs. 58.5%, p = 0.049), whereas 41.5% of controls required 3 procedures. In total, 82 trocars were used in the Cutanplast group versus 99 in controls. The single-step Cutanplast plug technique reduced operating times compared with two-step suturing techniques. CONCLUSION: Closure of port-site trocar incisions using Cutanplast plug is fast, efficient, with potential to reduce operating times and decrease bleeding and herniation from port-site trocars insertion, particularly in obese patients.