title: SPIDER ® sleeve gastrectomy--a new concept in single-trocar bariatric surgery: initial experience and technical details.
abstract: BACKGROUND
  Single port instrument delivery extended reach (SPIDER(®)) surgical system is a revolutionary surgical platform that allows triangulation of the surgical instruments while eliminating the crossing of instruments, the problematic characteristic of single access laparoscopic surgery.
  
  
  METHODS
  The purpose of this study was to analyze our initial experience with SPIDER(®) sleeve gastrectomy and to present the technical details of this new minimally invasive approach, performed in ten patients at the La Casamance Private Hospital between November 2012 and April 2013. All patients were reviewed at scheduled post-operative consultations at 1, 3 and 6 months. In addition to clinical examination, the post-operative consultation at one month also included a satisfaction survey using the Moorehead-Ardelt questionnaire.
  
  
  RESULTS
  An initial series of ten sleeve gastrectomies were performed in female patients with a mean age of 41.5 years (range: 2-52). The mean BMI was 40.11 (range: 37.25-44.3). The intervention was performed through a single trocar in all patients with no "conversion" to classic laparoscopy or open surgery. The mean operative time was 61 ± 15.22 minutes (SD=standard deviation) (range: 43-96 min). The mean BMI at one month was 35.5 (SD:± 3.58, SEM: ± 1.13) (SEM=standard error of mean) with an average percentage of excess weight loss (%EWL) of 32.9% (SD:± 8.56%, SEM:± 2.71%). The mean BMI at three months was 32.4 (SD: ± 2.78, SEM: ± 0.88) with an average %EWL of 52.7% (SD: ± 8.64%, SEM: ± 2.73%). The mean BMI at six months was 29.9 (SD:± 2.60, SEM: ± 0.98) with a mean %EWL of 68.8% (SD: ± 8.38%, SEM:± 3.17%). Complete remission of co-morbid conditions was observed in four patients, improvement in three others, and no change in a single patient. The mean duration of hospitalization was 3.1 days. The mean follow-up period was 161 days (SD:± 57.4 days, range: 90-243 days). There was no mortality and no intra-operative and post-operative complications were noted.
  
  
  CONCLUSIONS
  The SPIDER(®) surgical platform seems to be a usable and effective method for performance of minimally invasive single-access sleeve gastrectomy, offering an easy and efficient operative procedure compared to other single-port systems. Prospective long-term studies are recommended before this approach can be validated to be of comparable efficiency to conventional multi-port laparoscopic surgery.
authors.affiliation: Hôpital Privé Casamance, 13400 Aubagne, France.
authors.forename: P
authors.initials: P
authors.lastname: Noel
authors.affiliation: Hôpital Privé Casamance, 13400 Aubagne, France; Service de chirurgie digestive A, hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France. Electronic address: nedelcu.marius@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Nedelcu
authors.affiliation: Hôpital du Sacré Cœur, 5400, boulevard Gouin Ouest, Montréal, QC, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Gagner
mesh_terms: D000328:Adult; D015897:Comorbidity; D004867:Equipment Design; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: SPIDER; Sleeve gastrectomy