Nicole, who is 27 and lives near Bristol, recently underwent a gastric sleeve operation to help with weight loss. Instead of the traditional procedure with multiple incisions, this one involved a single small cut.
"By the time I went home, I didn't need pain medications, so that was nice," she said. "And I was happy to have no scars on my body."
Traditional laparoscopic surgery requires multiple incisions. Inside the body, the instruments converge to create a sort of tent that gives the surgeon room to operate.
With single-incision laparoscopic surgery, the kind performed on Nicole, a half-inch cut is made in the umbilicus, or bellybutton. Surgical tools enter the body with the help of a round instrument with three holes that guide the three long instruments — one with a small camera — in the right direction. The surgeon watches a video screen to find his or her way around. Before cameras were introduced to surgery, all incisions were considerably larger.
The April 5 surgery was performed by Dr. Makram Gedeon at Bristol Hospital, where officials said it was the first single-incision gastric sleeve surgery done in the state.
Gedeon has performed single-incision surgeries before, but this was the first time he applied it to the gastric sleeve procedure, which is relatively new in the field of bariatric, or weight loss, surgery. Two more common procedures are gastric bypass and gastric banding. With a gastric bypass, staples are used to decrease the size of a patient's stomach. With gastric banding, a band is placed on the stomach, dividing it into two pouches.
The gastric sleeve procedure involves removing most of the stomach. Besides leaving less room for food, it also removes the portion of the intenstine that secretes ghrelin, a hunger-causing hormone.
That the procedure is offered at Bristol Hospital is a particular point of pride for Gedeon.
"We're happy that a community hospital like ours can provide such cutting-edge surgery," said Gedeon, who has been with Bristol Hospital for 11/2 years. "Single-incision surgery is a very exciting new field. It's going to explode in the U.S."
The most obvious advantage is cosmetic. Because the surgery involves one small cut in the bellybutton, there are no visible scars afterward. Other benefits are anecdotal. There hasn't been enough research to say so conclusively, but Gedeon said there appears to be a shorter recovery time and less post-surgery pain. The risk of infection is also potentially lower, he said.
"When you achieve all those things, that's good," Gedeon said. He performed his first single-incision laparoscopic procedure about a year ago, a gallbladder surgery. He later used single-incision surgery for appendectomies. Gedeon took a few courses to train for those procedures.
"It is difficult, and it requires appropriate surgical skill," he said. "You lose a certain amount of freedom of movement."
No formal training is offered yet for single-incision gastric sleeve surgery, but Gedeon said his previous experience with the other procedures was enough to guide him through. "The real learning curve was with the gallbladder removal," he said.
Single-incision surgery isn't appropriate for every patient; it depends on physical type. Internal organs in the patient's torso must be close enough so the instruments will reach them.
And because the procedure is new, the surgical tools available are somewhat limited.
Dr. Jim Elsey, who serves on the patient education committee of the American College of Surgeons, said the procedure is quickly becoming a common one, and he expects it won't be long before there's a greater variety of instruments for the procedure.
Elsey added that the American College of Surgeons has deemed single-incision surgery to be as safe as traditional laparoscopic surgery.
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