Laparoscopic Sleeve Gastrectomy (LSG) is a popular surgical weight-loss intervention. Specimen extraction is a challenging step and carries potential morbidity. The purpose of this study is to utilise a video to describe the use of a wound protector (Small Medtronic Surgisleeve TM), Endoloop (Johnson and Johnson Endoloop R) and extraction bag (Medtronic Endo Catch TM) to facilitate specimen extraction.
Once the sleeve is fashioned, an Endoloop deployed through the right upper quadrant 5 mm trocar is secured to the pyloric end of the resected stomach.
The wound protector is placed through the 15 mm right iliac fossa access trocar after removal of the air seal mechanism, guided by direct laparoscopic visualisation. The wound protector is tensioned before the extraction bag is deployed through the now replaced RIF trocar. The specimen is delivered to the surface by traction on the Endoloop.
Finally, closure of the 15 mm fascial defect is carried out using a Ranfac Puncture Closure Device (Suture Grasper TM).
The technique has been adopted safely in 30 subjects. The simplicity and speed relative to conventional technique has been confirmed. The incidence of trocar site infection is the subject of ongoing study.
The benefits of wound protectors in reducing wound morbidity in clean contaminated cases has been highlighted in a recent meta-analysis.
The wound protector provides radial dilatation of the extraction port, whilst the combination of an Endoloop and extraction bag has the potential to reduce trocar site infections and facilitates specimen extraction.