title: Achieving the "Minimal Scarring" Concept in Bariatrics by Port-Site Relocation.
abstract: BACKGROUND
  The aim of single incision laparoscopic surgery (SILS) and other types of trans-umbilical procedures (TU) has been to perform operations with minimal or no visible scars. However, in bariatric surgery, they are in particular demanding and the final esthetic advantage is in question given the long-term abdominal skin alteration, or abdominoplasty. We propose an alternative rationale and approach to achieve the minimal scarring concept in bariatric surgery.
  
  
  METHODS
  A retrospective report of a straight forward method using four access ports, where three ports are concealed at either the lower panniculectomy region or the lateral folds of the umbilicus. The technique was performed on a pilot series of 65 female patients who underwent laparoscopic sleeve gastrectomy (LSG).
  
  
  RESULTS
  The study sample had a mean age of 40.3 years and a mean BMI of 41.1 ± 4.2 kg/m(2). All procedures were completed laparoscopically. Field ergometry, working angles, and surgeon's convenience were not impaired. Mean operation time was 46 min and mean hospital stay was 2.3 days. Complications were minimal. Postoperative esthetic outcome and the rationale behind port placement were well appreciated by the patients.
  
  
  CONCLUSIONS
  Performing LSG with the described approach is feasible, safe, and consistent with basic principles of ergometry including correct working triangulation. Esthetic outcome is up to the minimal scarring concept and future body contouring is not hampered.
authors.affiliation: Department of Surgery C, Chaim Sheba Medical Center, 2 Sheba Rd., Tel Hashomer, 56261, Israel. hadarspivak@gmail.com.|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. hadarspivak@gmail.com.|Herzelia Medical Center, 7 Ramat Yam St., Herzliya, 46140, Israel. hadarspivak@gmail.com.
authors.forename: Hadar
authors.initials: H
authors.lastname: Spivak
authors.affiliation: Department of Surgery C, Chaim Sheba Medical Center, 2 Sheba Rd., Tel Hashomer, 56261, Israel.
authors.forename: Lior
authors.initials: L
authors.lastname: Segev
authors.affiliation: Department of Surgery C, Chaim Sheba Medical Center, 2 Sheba Rd., Tel Hashomer, 56261, Israel.|Herzelia Medical Center, 7 Ramat Yam St., Herzliya, 46140, Israel.
authors.forename: Chanan
authors.initials: C
authors.lastname: Meydan
authors.affiliation: Herzelia Medical Center, 7 Ramat Yam St., Herzliya, 46140, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Yosef
authors.affiliation: Department of Surgery C, Chaim Sheba Medical Center, 2 Sheba Rd., Tel Hashomer, 56261, Israel.
authors.forename: Itai
authors.initials: I
authors.lastname: Ronen
authors.affiliation: Department of Plastic and Reconstructive Surgery, Asaf Harofeh Medical Center, Zerifin, 70300, Israel.
authors.forename: Lior
authors.initials: L
authors.lastname: Heller
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Ports minimization; Single incision laparoscopic surgery SILS; Single-incision; Trans-umbilical procedures TU; Trans-umbilical single-access