Table Of ContentJérôme Dargent
Innovative Technologies
and Non-Invasive Procedures
in Bariatric Surgery
123
Innovative Technologies and Non-Invasive
Procedures in Bariatric Surgery
Jérôme Dargent
Innovative Technologies and
Non-Invasive Procedures in
Bariatric Surgery
Jérôme Dargent
Polyclinique Rillieux
Lyon
France
ISBN 978-2-8178-0403-3 ISBN 978-2-8178-0404-0 (eBook)
DOI 10.1007/978-2-8178-0404-0
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Principles of a Directory
At fi rst glance, bariatric surgery seems well established in many countries around
the world, and gaining popularity along with the continuous increase of the morbidly
obese population. Yet the vast majority of the obese population does not take advan-
tage from the surgical possibilities. Clinical research should be oriented towards
less invasive procedures that could be accepted by the mainstream. In 2013, most of
non-invasive bariatric techniques are not standardized and suf fi ciently assessed, but
they are being constantly upgraded.
The purpose of the 1st and 2nd International Meetings on Non Invasive
Bariatric Techniques (Lyon, France, May 13–14, 2011 and April 20–21, 2012;
www.noninva-obesity.com ) has been to elicit discussion among experts from
worldwide, and gather relevant information on new technologies that will make
it possible to enlarge the vision of bariatric cares to a growing number of morbid
obese and non-morbid obese patients.
The program had been divided into fi ve parts, and established the guidelines for the
present directory: (1) Procedures that aim at lowering the “surgical trauma”, mostly
the single-trocar and the NOTES approaches. They raise important questions. Do we
have the instruments we need? Is the upgrade relevant versus the typical lap-approach?
(2) Techniques that are available through “natural ori fi ces”, the most promising pro-
vided they can prove satisfactory and long-standing. (3) New technologies, like neuro-
modulation. (4) Transversal issues: the role of the anesthesiologist, the cooperation of
the gastro-enterologist, etc. (5) Guidelines for the foreseeable evolutions.
Surgical procedures that are well known and accepted in 2012 (gastric bypass,
adjustable band, sleeve gastrectomy) were not explicitly addressed as such, but only
from the perspective of comparison and confrontation with less invasive procedures.
Figuring out the transition from mini-invasive to non-invasive may be described
with the following steps: (1) Picking-up procedures with medium aggressiveness
such as SILS and NOTES, as well as parallel concepts like neuro-modulation. (2)
Seeking concept similarities: endo-stapling/VBG, endo-sleeve/BPD, endoplication/
surgical plication, internal/external bands, etc. (3) Organizing strategies: combining
experimental and well-known techniques, stepping up the invasive degree; in this
regard, endoscopic redo for failed procedures is a promising direction.
v
vi Principles of a Directory
Bariatric surgery is rapidly and highly evolving, and less aggressive procedures
are an absolute necessity. Nonetheless, alternatives should be tested in a timely
manner, such as stated in the ASMBS recommendations (Statements on emerging
endosurgical bariatric interventions, SOARD, 2009).
We chose to pick up interesting and recent abstracts (or the relevant ones) per-
taining to each topic; some are quoted in extenso, some are rearranged. An illustra-
tion has been provided for most techniques.
ATTENTION : Many if not most of the operations herein described are under
scrutiny and/or investigation, with o r without the support o f major international
or national scienti fi c societies. Some of the devices do not have an of fi cial approval
yet (CE market-approval, F DA acknowledgment), and some have not been tested
in humans. Some have even been shut down, but represent an interesting step that
can bene fi t to other techniques. This is a highly evolving fi eld, so please apologize
errors and imprecisions. Corrections will be made in the next edition.
Lyon, France Jérôme Dargent
Contents
1 A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABILITI® System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Anaesthesia: Less Invasive Approach in the Obese Patient;
Anaesthesiology for Non Invasive Bariatric Surgery. . . . . . . . . . . . . . . . 1
Anti-reflux Endoscopic Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Anubis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2 B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Benchmarking of Novel Technologies in Bariatric Surgery . . . . . . . . . . 9
3 C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Cooperation Between the Bariatric Surgeon
and the Endoscopist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
4 D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Double Intra Gastric Balloon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Duodeno-Jejunal Bypass Sleeve: A Novel Approach
for Type 2 Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
5 E. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Endo-Flip System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Endoluminal Vacuum Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Endoscopic Re-do for Failed Gastric Bypass . . . . . . . . . . . . . . . . . . . . . 20
Endoscopic Re-do for Failed Sleeve Gastrectomy. . . . . . . . . . . . . . . . . . 20
Endoscopic Stapling for Morbid Obesity. . . . . . . . . . . . . . . . . . . . . . . . . 20
Endoscopic Therapy for Weight Regain After Gastric Bypass . . . . . . . . 20
Endoscopic Treatment of Post-op Complications After Gastric
Bypass and Sleeve Gastrectomy (Leaks, Stenosis) . . . . . . . . . . . . . . . . . 20
Expectations Among Surgeons Regarding Endoluminal Therapies . . . . 26
vii
viii Contents
Extra-Gastric Adjustable Balloon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Externally Adjustable Gastric Balloon . . . . . . . . . . . . . . . . . . . . . . . . . . 27
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
6 F. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Flexible Endostitch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Full Sense System for Obesity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
7 GH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Gastric Balloon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Gastric Balloon Without Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Gastric Plication (Laparoscopic Greater
Curve Plication or LGCP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Gastric Plication Associated with Banding . . . . . . . . . . . . . . . . . . . . . . . 41
G-Prox for Morbid Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
8 IJK. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Ileal Transposition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Injection at the GE Junction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Intra Gastric Injection of Botulinum Toxin . . . . . . . . . . . . . . . . . . . . . . . 47
Intra Gastric Injection of Satiety-Hormone-Producing Cells . . . . . . . . . 47
Internally Adjustable Gastric Balloon. . . . . . . . . . . . . . . . . . . . . . . . . . . 47
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
9 L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Laparoscopic Gastric Plication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Laparoscopic Instruments for Gastric Plication. . . . . . . . . . . . . . . . . . . . 51
Laparoscopic Micro-Instrumentation. . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
10 M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Magnetic Internal Video . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
MID-Sleeve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Reference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
11 N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Neuromodulation in Obesity Treatments. . . . . . . . . . . . . . . . . . . . . . . . . 59
VBLOC Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
NOTES Bariatric Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
NOTES Sleeve Gastrectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
12 O.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Overstitch Endoscopic Suturing System (OESS) . . . . . . . . . . . . . . . . . . 67
OVESCO System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Contents ix
13 PQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
PEG Drainage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
POSE Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Powered Stapling Device. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Pressure Guided Adjustments After Laparoscopic Adjustable Band . . . 70
Reference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
14 R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Reshape Intra Gastric Balloon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Restore Suturing System (TRIM Procedure). . . . . . . . . . . . . . . . . . . . . . 73
Robotic Needle-Holder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
ROSE Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Reference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
15 S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Safestitch Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
SILS Laparoscopic Bilio Pancreatic Diversion . . . . . . . . . . . . . . . . . . . . 77
SILS Laparoscopic Gastric Banding . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
SILS Laparoscopic Gastric Bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
SILS Lap-Band Removal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
SILS Sleeve Gastrectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
SILS Trocars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Spiderman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Stents for Staple-Line Leaks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Stomaphyx. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
16 TU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
TANTALUS Device. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
TERIS Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
TOGa Device. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Transport G-Prox “ROSE” for Re-do After
Failed Gastric Bypass and “POSE” for Primary Cases . . . . . . . . . . . . . . 89
Transpyloric Shuttle® (Baronova) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
17 VWXYZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
ValenTX System for Morbid Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
