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MIDSLEEVE™ gastric tube - improving calibration
In many countries in the world, laparoscopic sleeve gastrectomy has overtaken gastric bypass has the popular procedure. Despite its popularity, the procedure can still result in complications due to technical failures such as misidentification of vital surgical landmarks, use of improper staple heights, inadvertent traction, unguided imbrications of the staple line, spiral coiling of the stomach and failure in identification of safe diameter at most vulnerable areas like antrum and GE junction1.
Some of these complications can be reduced or eradicated by using an internal calibration device – such as the MIDSLEEVE™ gastric tube (Medical Innovation Developpement, MID). Bariatric News talked to Dr David Nocca from University Hospital, Montpellier, France, about the limitations of current gastric tubes and his experience with the MIDSLEEVE™ device. The bariatric team from Montpellier University Hospital is an internationally renowned expert bariatric centre and they carried out the first European multicentre study for the evaluation of the efficacy of laparoscopic sleeve gastrectomy in 2008.
“The Faucher tube is the most used calibration device for laparoscopic sleeve gastrectomy. However, the tube has several limitations including the need to use a second gastric tube because it is not possible to deflate the stomach (liquid) at the beginning or the end of the operation” he began.
“In addition, the material is not enough rigid to allow the anaesthesiologist to set up the tube during the procedure and we have previously placed the tube in a fridge to increase its rigidity. Finally, Faucher tube does not facilitate an accurate calibration of the Antrum, crucial for successful laparoscopic sleeve gastrectomy.
Dr Nocca explained that the MIDSLEEVE™ gastric tube has been designed to help overcome these limitations, allowing surgeons to perform a standardised laparoscopic sleeve gastrectomy and assisting the anaesthesiologist who can insert the device before the creation of the incision.
According to Dr Nocca the advantages of the MIDSLEEVE™ device are:
- Sterile silicone material more rigid with a consensual size - 12.5mm diameter (37.5Fr): the
- anaesthesiologist will place the MIDSLEEVE™ device in the oesophagus before the beginning of the surgery.
- Quality of calibration: the surgeon will know where precisely the pylorus is located and they will decide the distance between it and the first staple line. For example, 50cc in the distal balloon will give a 5-6cm length.
- The device is connected to a suction system for easy removal of air or fluid in the patient’s stomach
“It must be noted that there is still controversy about the size of the antrum removal during a sleeve gastrectomy and there is no evidence-based medicine to define the best shape,” he added. “Therefore, each surgeon will choose the size of the Antrum removal and should evaluate their results with more accuracy.”
“With regards to the use of MIDSLEEVE™, we have to emphasise that the anaesthesiologist must check the position of the blue line at the right level of the mouth in order to set up the balloon in the direction of the pylorus. During the balloon insufflation, the surgeon may have to find the right position using his graspers,” Dr Nocca advised. “We have to note that the surgeon has to systematically deflate the balloon and ask the anaesthesiologist to move the tube in order to avoid cutting the tube or the balloon. In one case in our series, a surgeon had to cut the balloon during the first gastric transection because he did not respect the advice of use.”
Dr Nocca added that a prospective randomised study, sponsored by the French Health Ministry, has been carried out in 2013 and compared the efficiency of laparoscopic sleeve gastrectomy with (Faucher tube) or without Antrum resection (MIDSLEEVE™) and the results will be published next year.
“My conclusion is that the MIDSLEEVE™ allows the surgeon to perform a highly standardised operation,” Dr Nocca added. “Importantly, the surgeons may choose the volume of the Antrum resection and evaluate the results of their technique with accuracy. The MIDSLEEVE™ is a real good option to teach our assistants and allows us to be confident that the same procedure is performed in each patient.”