SILS Nissen fundoplication

Patients undergoing gastrointestinal surgery had only two surgical options: conventional open surgery or laparoscopic surgery with multiple incisions. Single incision laparoscopic surgery may become the preferred method of the future. Patients experience less pain and quicker recovery. Patients also enjoy the cosmetic benefit of fewer visible postoperative scars. This video shows a SILS Nissen fundoplication respecting all steps of the conventional approach.

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SILS Nissen fundoplication

Authors

T Tran Ba, J Ebels, D Burnon

Abstract

Patients undergoing gastrointestinal surgery had only two surgical options: conventional open surgery or laparoscopic surgery with multiple incisions. Single incision laparoscopic surgery may become the preferred method of the future. Patients experience less pain and quicker recovery. Patients also enjoy the cosmetic benefit of fewer visible postoperative scars. This video shows a SILS Nissen fundoplication respecting all steps of the conventional approach.

Classification

new techniques, single port, contribution

Keywords

SILS Nissen fundoplication

Media type

Surgical video

Duration

06'35''

Publication

2009-12

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E-publication

WeBSurg.com, Dec 2009;9(12).
URL: http://www.websurg.com/doi-vd01en2833.htm

SILS Nissen fundoplication

1. Single port introduction 00'22''

In this video, we show the use of the Covidien SILS™ Procedure kit. The single port is introduced at epigastric level, slightly to the left in order to avoid passing through the liver’s suspensory ligament.

2. Liver retraction using elastic bands 00'37''

Elastic bands are placed on the diaphragmatic peritoneum and the liver is suspended using 2/0 Ethibond sutures fixed to the end of the band. Here we can see the external view of the fixation.

3. Lesser omentum opening 01'34''

The procedure starts as is done routinely by opening the inferior part of the lesser omentum towards the phrenoesophageal membrane.

4. Angle of His dissection 01'49''

The esophagogastric angle (angle of His) is dissected; this is the trickiest part of the procedure. For this dissection, you can also use the Endo-dissect roticulator®.

5. Freeing of esophagus 02'21''

The esophagus is freed from the right and left diaphragmatic crura. A Penrose drain is passed through in order to expose and reduce the esophagus in the thorax over 5 to 7cm.

6. Gastrolysis 04'15''

A gastrolysis of the vessels originating from the left gastro-omental vessels and short gastric vessels is performed. The floppy valve is checked.

7. Crura suture 05'09''

The diaphragmatic crura are sutured; in this case, a stitch of Ethibond 2/0 is sufficient. A 34 French calibration tube is passed through.

8. Valve creation 05'56''

The valve is performed over 360 degrees using three Ethibond 2/0 stitches. A test is performed with another passage of the calibration tube in order to avoid a stenosis or a postoperative dysphagia. A control gastrograffin enema is carried out on postoperative day 2.