title: Single-incision laparoscopic sleeve gastrectomy versus conventional multiport laparoscopic sleeve gastrectomy: technical considerations and strategic modifications.
abstract: BACKGROUND
  Since its inception, minimal access surgery has been a dynamic field, experiencing successive leaps in technique and instrumental design. Each improvement in minimal access surgery must demonstrate that patients benefit from the change in approach, without compromising the outcome. The present study presents the technical considerations and strategic modifications for single-incision laparoscopic sleeve gastrectomy. We also compared the newly adopted single-incision laparoscopic approach with conventional multiport laparoscopic sleeve gastrectomy.
  
  
  METHODS
  Of the 26 patients included in the present study, 14 underwent single-incision laparoscopic sleeve gastrectomy and 12 underwent conventional multiport sleeve gastrectomy. All procedures were performed by the same surgeon (A.A.S.) during a 12-month period from September 2008 to August 2009 at Michigan State University Kalamazoo Center for Medical Studies.
  
  
  RESULTS
  The Mann-Whitney U tests showed with 95% confidence that the difference in pain scores and length of hospital stay in the single-incision laparoscopic sleeve gastrectomy group were statistically significant. A modest increase occurred in the operative time in the single-incision laparoscopic sleeve gastrectomy group. This difference was the least statistically significant of all variables (P = .055).
  
  
  CONCLUSIONS
  Single-incision laparoscopic sleeve gastrectomy was associated with less postoperative pain, a lower need for analgesia, and a decreased length of hospital stay compared with conventional multiport laparoscopic sleeve gastrectomy. This was achieved without decreasing the quality of surgery or the outcomes offered by the conventional multiport counterpart.
authors: Department of Surgery, Case Western Reserve University Hospital, Cleveland, Ohio 44106, USA. alan.saber@uhhospitals.org
authors: Alan A
authors: AA
authors: Saber
authors: Tarek H
authors: TH
authors: El-Ghazaly
authors: Aditya V
authors: AV
authors: Dewoolkar
authors: Sunao A
authors: SA
authors: Slayton
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D005743:Gastrectomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D011300:Preoperative Care; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome