Minimally Invasive Surgery

What Is Minimally Invasive Weight Loss Surgery?

Minimally invasive bariatric surgery (also known as laparoscopic bariatric surgery) means completing your weight loss surgery without having to make a large, open incision. Types of minimally invasive weight loss surgery include laparoscopic weight loss surgery, single site weight loss surgery, robotic weight loss surgery, and endoscopic techniques (NOTES and EBT) that can sometimes be applied in a revisional setting without making any external incisions at all. Many of these are new approaches, and laparoscopic surgery usually remains the best option for patients. However, it’s important for patients to understand all of their choices.

What is Non-Invasive Weight Loss Surgery?

Non-invasive weight loss procedures include the Stretta and the Reshape Duo Balloon (or gastric balloon). Non-invasive weight loss procedures do not involve any incisions or surgery. However, these procedures typically result in lower weight loss than a minimally invasive weight loss surgery such as the roux-en-y gastric bypass as well as a strong trend toward weight regain long-term.

As such, at the Bariatric and Metabolic Center of Colorado, we offer minimally invasive surgeries that have a proven ability to help you on your weight loss journey; rather than non-invasive weight loss procedures that may carry long-term risks and offer less effective weight loss.

What Is Laparoscopic Bariatric Surgery?

Laparoscopic bariatric surgery is a type of minimally invasive bariatric surgery that involves making 4 to 5 very tiny incisions, about as wide as your little fingernail, where a variety of surgical instruments are introduced to complete the surgery without needing a large open incision. This is the least invasive weight loss surgery. Benefits of laparoscopic surgery generally include the following:

• Smaller, more cosmetic incisions
• Less pain
• Shorter hospitalization
• Quicker return to activity
• Fewer wound complications

What Is Single Site Bariatric Surgery?

Single site surgery (also known as Single Incision Laparoscopic Surgery- or SILS^TM) involves making one slightly larger incision, usually through the belly button, where multiple instruments are inserted. At the BMCC we offer this approach for the sleeve gastrectomy, but not for the gastric bypass or duodenal switch. However, you will usually see just as good, if not better, results from a cosmetic perspective with laparoscopic surgery.

Please ask your surgeon if you would be a good candidate if you are interested in the sleeve gastrectomy, single site surgery, or would like more information.

What Is Robotic Bariatric Surgery?

This approach uses a robot to control the instruments used for surgery. Our bariatric surgeon, Dr. Long, helped pioneer the development of novel robotic thoracic techniques during his fellowship at UAB.

Although this technique has proven useful in thoracic and pelvic surgery, when it comes to bariatric surgery, robots do not outperform skilled bariatric surgeons. Additionally, robotic bariatric surgery may actually come with slightly more risk than traditional surgery, because it requires greater duration of anesthesia and as a result may expose patients to greater risk. It also requires larger incisions.

In a few years robotic bariatric surgery may become safer and/or more effective than the laparoscopic approach. At this point in the future, robotic surgery may be a good option for patients seeking gastric sleeve surgery, gastric bypass surgery, or other bariatric procedures.

However, at the current time highly skilled laparoscopic surgeons offer the best approach.

What Is NOTES (and EBT)?

NOTES (Natural Orifice Transluminal Endoscopic Surgery) is an emerging field of endoscopic surgery. A NOTES procedure uses an endoscope with small advanced instruments passed down the esophagus and into the stomach where scarless weight-loss surgery on the stomach and small intestine can be completed. This is different than the laparoscopic bariatric surgical approach, which uses small incisions in the abdominal wall. Bariatric NOTES procedures are now being developed and are called Endoscopic Bariatric Therapies (EBT).

NOTES and EBT are still emerging fields. While they can accomplish scarless surgery, at this point in time, questions remain about the durability of their outcomes long-term. As such, at the BMCC we don’t typically recommend that patients choose this approach for a primary weight loss operation, however they may have a role if revision is needed.

Is Minimally Invasive Weight Loss Surgery Right for Me?

Minimally invasive bariatric surgery can help you to lose your excess weight and keep it off. Many of our patients lose 100 to 150 pounds or even more when they combine a bariatric surgery procedure with diet and exercise, and keep the weight off. That kind of long-term weight loss can be life-changing.

At the Bariatric and Metabolic Center of Colorado, we offer four powerful types of weight loss surgery:

• Roux-en-y gastric bypass surgery
• Biliopancreatic diversion with duodenal switch
• Sleeve gastrectomy
• LAP-BAND® revisional surgery

(We do not offer LAP-BAND® surgery, because gastric banding surgery has proven to be ineffective and unsafe. We do not offer the gastric balloon, Endoscopic Sleeve Gastroplasty, or VBLOC therapy because there are concerns about their safety and long-term efficacy).

The laparoscopic roux-en-y gastric bypass is the gold standard in terms of weight loss surgical procedures. Patients who undergo gastric bypass surgery often lose 65-90% of their excess weight and keep it off. The gastric bypass is also effective at curing Type II diabetes.

Because each of our surgeries can be performed laparoscopically, and because we use a cutting-edge TAP-block to reduce your pain during and after surgery, recovery is generally fast and patients report very little pain.

Minimally invasive weight-loss surgery isn’t completely non-invasive, so there will be a small amount of scarring. But it’s important to note that morbid obesity comes with many risks, from sleep apnea to high blood pressure, and is very taxing on your body. A comprehensive bariatric surgery program can help you lower your BMI, cure your obesity, and lose weight for good. Ultimately, long-term weight loss represents a gift that you can give yourself and your body, which our patients have found far outweighs the small scarring from the weight-loss procedure.

Which Minimal Access Surgery Is Right For Me?

While the new fields of minimal access surgery are promising, laparoscopic surgery remains the safest, most effective, and cosmetically best approach to weight-loss surgery for most patients. While Dr, Long participated in the development of novel robotic procedures, this platform does not yet show a clear benefit. Studies have shown that robotic bariatric surgery does not hold any significant advantages over laparoscopic bariatric surgery when the laparoscopic surgeon is highly trained and skilled. This may not always be true when revisional bariatric surgery is needed, but holds true for initial procedures.

Single site surgery can also be performed for the sleeve to decrease the number of incisions to 1. However, most people find that their cosmetic benefit is better with a few very small incisions rather than one that is a little larger, and prefer laparoscopic minimally invasive surgery. Finally, a NOTES (endoscopic no incisions) bariatric procedure known as the ROSE (restorative obesity surgery endolumenal) can be a consideration for some revisional bariatric surgeries.