title: Laparoscopic Three-Port Sleeve Gastrectomy: A Single Institution Case Series.
abstract: BACKGROUND
  Further minimization of abdominal wall trauma during laparoscopic bariatric surgery is a topic of great interest. Reducing the number of trocars may provide superior cosmetic results with less pain and shorter length of stay (LOS). However, it remains unclear if this approach compromises safety or effectiveness of weight loss. The aim of this study is to report initial safety and feasibility results using a three-port minimally invasive sleeve gastrectomy technique.
  
  
  METHODS
  A retrospective review of patients who underwent laparoscopic three-port sleeve gastrectomy (3PSG) at our institution was conducted. Patient demographics, intraoperative parameters, and perioperative outcomes were extracted and analyzed. Postoperative data were obtained from routine follow-up history and physical examination.
  
  
  RESULTS
  From May 2013 to April 2014, 45 morbidly obese patients underwent 3PSG. The cohort had a male-to-female ratio of 20:25, mean age of 47.4 ± 11.6 years, and a mean preoperative body mass index (BMI) of 47.6 ± 9.7 kg/m(2). The mean number of comorbidities was 4 (range 0-8), and the mean American Society of Anesthesiologists score was 2.82 (range 1-4). Mean procedural duration and blood loss were 165 ± 31.9 minutes and 27.0 ± 31.8 mL, respectively. Eight patients (17%) required one additional trocar. Two cases (4.4%) had an intraoperative complication (staple line bleeding and splenic capsule laceration). Two (4.4%) postoperative complications were encountered (wound infection and axillary vein thrombosis). The mean LOS was 2.7 (range 2-7) days. At a mean follow-up of 5 (range 0.4-11.7) months, the cohort had a mean BMI of 40.0 ± 9.26 kg/m(2), which corresponded to a mean excess weight loss of 36.0% ± 18.1%. There were no trocar site hernias. All patients were highly satisfied with the final cosmetic result.
  
  
  CONCLUSIONS
  Laparoscopic 3PSG appears to be a safe and feasible technique for performing sleeve gastrectomy. While further long-term research is needed, it appears to have significant benefits, mainly patient satisfaction and potentially less pain.
authors.affiliation: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.|2 Fundació Clínic per la Recerca Biomèdica, Hospital Clínic of Barcelona , Universitat de Barcelona, Barcelona, Spain .
authors.forename: Ricard
authors.initials: R
authors.lastname: Corcelles
authors.affiliation: 3 Digestive Disease Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mena
authors.initials: M
authors.lastname: Boules
authors.affiliation: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Dvir
authors.initials: D
authors.lastname: Froylich
authors.affiliation: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Christopher Ryan
authors.initials: CR
authors.lastname: Daigle
authors.affiliation: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Amani
authors.initials: A
authors.lastname: Hag
authors.affiliation: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Phillip R
authors.initials: PR
authors.lastname: Schauer
authors.affiliation: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.|4 Case Western Reserve University, School of Medicine, University Hospitals, Cleveland, Ohio.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rogula
mesh_terms: D015992:Body Mass Index; D004867:Equipment Design; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000295:instrumentation*; D016896:Treatment Outcome; D015431:Weight Loss