title: Initial experience of single-port surgery assisted by percutaneous instruments for gastric bypass: a combination of safety and minimally invasive surgery.
abstract: BACKGROUND
  We present here the first reported cases of patients undergoing gastric bypass with a hybrid technique that involves a new concept of percutaneous instruments and provides the advantages of minimally invasive single-port surgery while maintaining the triangulation, safety, and timing of operative procedures.
  
  
  METHODS
  This was a prospective pilot study of eight patients selected for gastric bypass between December 2011 and January 2012 and treated by a technique that combined single SSL port and percutaneous surgical set PPS. We performed hand-sewn gastrojejunostomy in all cases. We analyzed preliminary results at 1 month and focused on the feasibility of the technique, duration of surgery, perioperative complications, and cosmetic results. The Ethics Committee of our institution approved this study and we obtained the informed consent of each patient.
  
  
  RESULTS
  We completed the procedure successfully in all patients. No conversions to laparotomy or classic laparoscopy were required. The average time of surgery was 112 min (85-155). Length of hospital stay was 4 days (3-5). One patient was re-admitted on the seventh postoperative day for gastrointestinal bleeding from the gastrojejunostomy suture and treated by endoscopic clipping. Residual scars were less than 2 cm for the single midline port and 2 mm for the percutaneous instruments.
  
  
  CONCLUSIONS
  This new technique combines the advantages of single-port surgery with the safety of conventional laparoscopy by using percutaneous instruments and leaves minimal scarring. It is likely that the use of percutaneous instrumentation will become widespread in all areas of laparoscopic surgery.
authors.affiliation: Department of Digestive Surgery, CHR Citadelle, Boulevard Line 12th, 4000, Liège, Belgium. nikotzam@yahoo.fr
authors.forename: Nikos
authors.initials: N
authors.lastname: Kotzampassakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Machairas
authors.forename: Mathieu
authors.initials: M
authors.lastname: Clanet
authors.forename: Pierre
authors.initials: P
authors.lastname: Cornet
authors.forename: Anne-Catherine
authors.initials: AC
authors.lastname: Dandrifosse
mesh_terms: D061645:Abdominoplasty / Q000379:methods*; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D061646:Operative Time; D061214:Patient Safety; D010865:Pilot Projects; D011446:Prospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome