How to Suture the Staple Line more Easily in Single-Port Sleeve Gastrectomy? Our Unique Method
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LETTER TO THE EDITOR
How to Suture the Staple Line more Easily in Single-Port Sleeve Gastrectomy? Our Unique Method Xuejing Zheng 1 & Yifan Guo 1 & Nengwei Zhang 1
&
Bin Zhu 1
Received: 24 July 2020 / Revised: 11 August 2020 / Accepted: 11 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Respected editor: Sleeve gastrectomy has been proven effective in managing patients with obesity as an isolated bariatric surgery. Bleeding and leakage are the two most challenging complications associated with sleeve gastrectomy. To prevent these complications, staple line enforcement methods are widely used. Suturing the staple line is generally recognized as an effective way to prevent bleeding, but leakage is still controversial [1]. Over half of all experts expressed that they reinforce the staple line by the suturing method [1]. Recently, several reports on the topic of single-port sleeve gastrectomy have been published. Single-port sleeve gastrectomy has advantages in improving aesthetics and reducing postoperative pain [2], but with great technical difficulty. We noted that suturing the staple line is widely performed in multi-port sleeve gastrectomy but rarely in single-port sleeve gastrectomy [2–11]. Alternatively, the staple line is only selectively over sewn when blood is being discharged at the staple line and is difficult to control [12, 13]. Laparoscopic suturing is not used routinely, although single-port sleeve gastrectomy has
Xuejing Zheng and Yifan Guo contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04922-5) contains supplementary material, which is available to authorized users. * Nengwei Zhang [email protected] * Bin Zhu [email protected] Xuejing Zheng [email protected] Yifan Guo [email protected] 1
Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Shijitan Hospital, Tieyi Road, Haidian District, Beijing 100038, China
become a routine procedure in some centers. Putting aside any doubts in its effectiveness, we hold the conception that the same surgical principle should be obeyed in both multiport and single-port sleeve gastrectomy procedures. Increased technical difficulty probably leads to a decreased frequency of suturing in single-port LSG [3]. Why is suturing more difficult in single-port LSG than in multi-port LSG? First, single-port instruments are placed in a relatively close and parallel position, which could result in a technical challenge, such as instruments collision both intracorporeal and extracorporeal. Second, a singleport device hinders the formation of triangulation among instruments from different abdominal sites compared with a multi-port device, which results in an imbalance in suturing and knotting. These two causes increase technical difficulties in bimanual loading of the needle and setting the needle angle to penetrate the target. How can these issues be resolved? We proposed a novel, unique suturing method call
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