Trocar number and placement for laparoscopic sleeve gastrectomy and comparison of single-incision and conventional laparoscopic sleeve gastrectomy: a systematic review and meta-analysis

Abstract

Background: Conventional laparoscopic sleeve gastrectomy (CLSG) has been conducted in multiple centers for treating morbid obesity, however, there are no standard criteria for (1) placing the trocar; and (2) how many trocars should be used. Single-incision laparoscopic sleeve gastrectomy (SLSG), a newly emerged technique in 2008, has been proposed as an alternative to CLSG in recent years, however, there is no definite evidence for this. Materials and methods: A systematic literature search was performed using the PubMed, Embase, Web of Science, and Cochrane Library databases for laparoscopic sleeve gastrectomy cases from January 2006 to October 2022. We then summarized the trocar numbers and placement patterns among these studies. A meta-analysis was conducted to compare the difference between SLSG and CLSG in the perioperative and postoperative indices. Results: A total of 61 studies involving 20 180 patients who underwent laparoscopic sleeve gastrectomy for treating morbid obesity were included in the systematic review, including 11 on SLSG, 35 on CLSG, and 15 studies comparing SLSG and CLSG. A systematic review showed that the trocar number varied in different CLSG studies, mainly using four or five trocars. The trocars were mainly placed in position, presenting an inverted trapezoid pattern and a left-predominant pattern. Meta-analysis showed that the operative time in the SLSG was significantly higher than that in the CLSG, and the pain Visual Analog Scale rating on postoperative day 1 in the CLSG was significantly higher than in the SLSG. There were no statistical significances in the other complications or surgical efficiency. Conclusions: In the CLSG, the majority of the trocars were arranged in an inverted trapezoid pattern and were of the left-predominant type. Although SLSG is a feasible technique in selected patients, there is insufficient evidence to recommend its widespread use compared with CLSG. High-quality randomized controlled trials with large study populations and long follow-up periods will be required in the future.

Does patient size matter when comparing the operation time between single-incision and conventional laparoscopic sleeve gastrectomy?

“…For CLSG procedures, they found that most studies utilized either four or five trocars arranged in an inverted trapezoid pattern, favoring the left side. A comparison between SLSG and CLSG showed a significantly longer operative time for SLSG but with lower pain scores on postoperative day 1 1 . There were no differences in other perioperative outcomes such as complications 1 .…”

“…A comparison between SLSG and CLSG showed a significantly longer operative time for SLSG but with lower pain scores on postoperative day 1 1 . There were no differences in other perioperative outcomes such as complications 1 . This is an important area of research, as bariatric surgery is gaining popularity as an effective treatment for obesity-related diseases.…”

“… 1 titled ‘Trocar number and placement for laparoscopic sleeve gastrectomy and comparison of single-incision and conventional laparoscopic sleeve gastrectomy: a systematic review and meta-analysis’ published in the International Journal of Surgery . The authors performed a systematic review and meta-analysis comparing single-incision laparoscopic sleeve gastrectomy (SLSG) with conventional laparoscopic sleeve gastrectomy (CLSG) for the treatment of morbid obesity 1 . Their review included 61 studies with over 20 000 patients.…”

“…As SLSG is still an emerging technique, evaluating its risks and benefits compared with the current standard CLSG is particularly valuable. The authors 1 should be congratulated on a robust systematic review and meta-analysis that contributes important new data to the literature.…”

“…However, the finding 1 that operative time was significantly longer in SLSG than in CLSG implies that SLSG is likely a more technically challenging procedure that requires a longer learning curve for surgeons and may not yet be ready to fully replace CLSG. This suggests the need for additional surgical training and expertise in SLSG before it can be widely recommended.…”