Transumbilical Single-Port Laparoscopic Adjustable Gastric Band Placement with Liver Suture Retractor

The evolution of single-incision laparoscopic surgery (SILS) has no doubt been impacted by the decrease or elimination of incisions seen with natural orifice transluminal endoscopic surgery (NOTES). SILS upholds the principal advantages of minimal access surgery including shortened hospital stays, the potential for decreased postoperative pain, and cosmetically acceptable scars by reducing large or multiple incisions to a relatively small, single one. As opposed to NOTES, SILS does not violate a natural orifice and so the potential for contamination is identical to that of laparoscopy. SILS also utilizes familiar technology regarding ports and instruments which make technical adaptation easier and costs remain essentially unchanged. Standard laparoscopic techniques for gastric band placement use up to six ports in various configurations to safely accomplish this procedure. We describe a 40-year-old female with a body mass index of 41 who underwent placement of a gastric band for weight reduction via a single incision. A novel liver retractor technique eliminated one of the typical incisions utilized in other described "single-incision" techniques. The total number of trocars used at the sole, transumbilical incision was three. The operative time was 58 min. There were no intraoperative or postoperative complications. The patient was discharged on postoperative day 1. Single-incision transumbilical placement of gastric band is safe and technically feasible. Evolution of this technique with improved instrumentation will facilitate its adoption.