Single-incision transumbilical laparoscopic adjustable gastric banding: a novel minimally invasive surgical technique.

Single-incision laparoscopic surgery is a new approach considered as an alternative to natural orifice transluminal endoscopic surgery. Here, we describe a novel technique for laparoscopic adjustable gastric banding (LAGB) using a single-incision transumbilical (SITU) approach and an intraoperative method for liver retraction. Three patients (18 to 23 y) with a mean body mass index of 38.1 kg/m2 underwent LAGB with the "pars flaccida" technique through an SITU approach. Retraction of the left liver lobe was achieved with a specially designed "liver suspension tape" attached with sutures to the left upper quadrant abdominal wall and midline. The mean operative time was 62 minutes, with no intraoperative complications. These patients responded well postoperatively and were discharged after 2 days. SITU-LAGB is a safe, technically feasible, and reproducible procedure resulting in a more beneficial cosmetic appearance as the incision wound is hidden in the umbilicus, thus avoiding visible abdominal scars.