What Is Minimally Invasive Surgery?
Minimally invasive surgery (also known as laparoscopic surgery) means completing your weight loss surgery without having to make a large, open incision. Types of minimally invasive 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 Laparoscopic Bariatric Surgery?
Laparoscopic bariatric surgery is a type of minimally invasive 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. 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 SILSTM) 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. 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. 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. 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. These procedures use an endoscope with small advanced instruments passed down the esophagus and into the stomach where scarless surgery 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.
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 bariatric 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) procedure known as the ROSE (restorative obesity surgery endolumenal) can be a consideration for some revisional surgeries.