Technical evolution and standardized clinical implementation of single-incision laparoscopic sleeve gastrectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HUANG Xingda , DONG Wenpei , YANG Jianjun ,  GU Yan

Department of General Surgery, Huadong Hospital, Fudan University, Shanghai 200040, P. R. China;

Corresponding author：

GU Yan, Email: yangu@fudan.edu.cn

Keywords：

single-incision laparoscopic surgery; laparoscopic sleeve gastrectomy; obesity; metabolic diseases

DOI：

10.7507/1007-9424.202508091

Video：

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Single-incision laparoscopic sleeve gastrectomy (SILSG) was first described in 2008, which could effectively control excess body weight and treat metabolic diseases relevant to obesity in a long term. Over more than a decade of refinement and technical advancement, precise and standardized surgical techniques have become critical for ensuring treatment efficacy and reducing postoperative complication rates. Thus, this review summarized the evolution of SISLG, further understanding and emphasizing the importance of standardized and precise surgical procedures.

1.	Phelps N H, Singleton R K, Zhou B, et al. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3 663 population-representative studies with 222 million children, adolescents, and adults. Lancet, 2024, 403(10431): 1027-1050.
2.	国家卫生健康委食品安全标准与监测评估司, 中国疾病预防控制中心营养与健康所, 成人肥胖食养指南编写专家组, 等. 成人肥胖食养指南(2024年版). 卫生研究, 2024, 53(3): 347-351.
3.	Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392.
4.	Salas-Parra RD, Smolkin C, Choksi S, et al. Bariatric surgery: current trends and newer surgeries. Gastrointest Endosc Clin N Am, 2024, 34(4): 609-626.
5.	Saber AA, El-Ghazaly TH, Dewoolkar AV, et al. Single-incision laparoscopic sleeve gastrectomy versus conventional multiport laparoscopic sleeve gastrectomy: technical considerations and strategic modifications. Surg Obes Relat Dis, 2010, 6(6): 658-664.
6.	Lakdawala MA, Muda NH, Goel S, et al. Single-incision sleeve gastrectomy versus conventional laparoscopic sleeve gastrectomy—a randomised pilot study. Obes Surg, 2011, 21(11): 1664-1670.
7.	International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). 8th IFSO Global Registry Report [monograph on the Internet]. Naples, Italy: IFSO; 2023 [cited 2025 Aug 1].
8.	Buchwald H. The evolution of metabolic/bariatric surgery. Obes Surg, 2014, 24(8): 1126-1135.
9.	Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg, 1994, 4(4): 353-357.
10.	刘家盛, 李士军, 闫瑞承, 等. 单孔腹腔镜袖状胃切除术与传统腹腔镜袖状胃切除术的对比研究. 临床外科杂志, 2020, 28(9): 826-829.
11.	Stryhn K, Alstrup L, Riber C, et al. Complications in patients undergoing laparoscopic bariatric surgery in an ERABS-optimized, high-volume, single center during 2020 and 2021. Obes Surg, 2023, 33(7): 2064-2071.
12.	Saber AA, Elgamal MH, Itawi EA, et al. Single incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg, 2008, 18(10): 1338-1342.
13.	李梦伊, 王桂琦, 于卫华, 等. 大中华减重与代谢手术数据库2024年度报告. 中国实用外科杂志, 2025, 45(5): 538-552.
14.	Rogula T, Daigle C, Dua M, et al. Laparoscopic bariatric surgery can be performed through a single incision: a comparative study. Obes Surg, 2014, 24(7): 1102-1108.
15.	Kang SH, Park YS, Ahn SH, et al. Laparoendoscopic single-site bariatric surgery: a review of single-port laparoscopic and endoscopic bariatric treatments. J Obes Metab Syndr, 2018, 27(1): 25-34.
16.	Sun SD, Wu PP, Zhou JF, et al. Comparison of single-incision and conventional laparoscopic sleeve gastrectomy for morbid obesity: a meta-analysis. Obes Surg, 2020, 30(6): 2186-2198.
17.	Ataya K, Bsat AM, Aljaafreh A, et al. Single incision versus conventional multiport laparoscopic sleeve gastrectomy: meta-analysis and systematic review. Cureus, 2023, 15(10): e46956. doi: 10.7759/cureus.46956.
18.	杨建军, 董文培, Jason Wadjaja, 等. 单孔腹腔镜胃袖状切除术265例临床分析. 中国实用外科杂志, 2024, 44(8): 906-910.
19.	王亮, 张璇, 李震, 等. 脐内2 cm小切口单孔腹腔镜胃袖状切除术8例体会. 中国微创外科杂志, 2018, 18(11): 993-996.
20.	Widjaja J, Yang J, Dong W, et al. Single-port one anastomosis sleeve gastrectomy with transit bipartition: initial experience and technique. Obes Surg, 2024, 34(7): 2739-2743.
21.	Yang J, Widjaja J, Wang R, et al. Routine gastric suspension technique in single-port sleeve gastrectomy procedure. Surg Endosc, 2023, 37(12): 9651-9657.
22.	Morales-Conde S, Peeters A, Meyer YM, et al. European Association for Endoscopic Surgery (EAES) consensus statement on single-incision endoscopic surgery. Surg Endosc, 2019, 33(4): 996-1019.
23.	Lainas P, Derienne J, Zervaki S, et al. Left hypochondrium or transumbilical single-incision laparoscopic sleeve gastrectomy for the treatment of severe obesity: surgical technique and results of a tertiary referral bariatric center. Obes Surg, 2021, 31(11): 5063-5070.
24.	Stefanopoulos A, Economopoulos KP, Kalles V. Single incision laparoscopic sleeve gastrectomy: a review. Obes Surg, 2015, 25(8): 1502-1510.
25.	Tranchart H, Rebibo L, Gaillard M, et al. Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis. Surgical Endoscopy, 2020, 34(9): 3978-3985.Tranchart H, Rebibo L, Gaillard M, et al. Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis. Surgical Endoscopy, 2020, 34(9): 3978-3985.
26.	Huang CK. Single-incision laparoscopic bariatric surgery. J Minim Access Surg, 2011, 7(1): 99-103.

1. Phelps N H, Singleton R K, Zhou B, et al. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3 663 population-representative studies with 222 million children, adolescents, and adults. Lancet, 2024, 403(10431): 1027-1050.
2. 国家卫生健康委食品安全标准与监测评估司, 中国疾病预防控制中心营养与健康所, 成人肥胖食养指南编写专家组, 等. 成人肥胖食养指南(2024年版). 卫生研究, 2024, 53(3): 347-351.
3. Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392.
4. Salas-Parra RD, Smolkin C, Choksi S, et al. Bariatric surgery: current trends and newer surgeries. Gastrointest Endosc Clin N Am, 2024, 34(4): 609-626.
5. Saber AA, El-Ghazaly TH, Dewoolkar AV, et al. Single-incision laparoscopic sleeve gastrectomy versus conventional multiport laparoscopic sleeve gastrectomy: technical considerations and strategic modifications. Surg Obes Relat Dis, 2010, 6(6): 658-664.
6. Lakdawala MA, Muda NH, Goel S, et al. Single-incision sleeve gastrectomy versus conventional laparoscopic sleeve gastrectomy—a randomised pilot study. Obes Surg, 2011, 21(11): 1664-1670.
7. International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). 8th IFSO Global Registry Report [monograph on the Internet]. Naples, Italy: IFSO; 2023 [cited 2025 Aug 1].
8. Buchwald H. The evolution of metabolic/bariatric surgery. Obes Surg, 2014, 24(8): 1126-1135.
9. Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg, 1994, 4(4): 353-357.
10. 刘家盛, 李士军, 闫瑞承, 等. 单孔腹腔镜袖状胃切除术与传统腹腔镜袖状胃切除术的对比研究. 临床外科杂志, 2020, 28(9): 826-829.
11. Stryhn K, Alstrup L, Riber C, et al. Complications in patients undergoing laparoscopic bariatric surgery in an ERABS-optimized, high-volume, single center during 2020 and 2021. Obes Surg, 2023, 33(7): 2064-2071.
12. Saber AA, Elgamal MH, Itawi EA, et al. Single incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg, 2008, 18(10): 1338-1342.
13. 李梦伊, 王桂琦, 于卫华, 等. 大中华减重与代谢手术数据库2024年度报告. 中国实用外科杂志, 2025, 45(5): 538-552.
14. Rogula T, Daigle C, Dua M, et al. Laparoscopic bariatric surgery can be performed through a single incision: a comparative study. Obes Surg, 2014, 24(7): 1102-1108.
15. Kang SH, Park YS, Ahn SH, et al. Laparoendoscopic single-site bariatric surgery: a review of single-port laparoscopic and endoscopic bariatric treatments. J Obes Metab Syndr, 2018, 27(1): 25-34.
16. Sun SD, Wu PP, Zhou JF, et al. Comparison of single-incision and conventional laparoscopic sleeve gastrectomy for morbid obesity: a meta-analysis. Obes Surg, 2020, 30(6): 2186-2198.
17. Ataya K, Bsat AM, Aljaafreh A, et al. Single incision versus conventional multiport laparoscopic sleeve gastrectomy: meta-analysis and systematic review. Cureus, 2023, 15(10): e46956. doi: 10.7759/cureus.46956.
18. 杨建军, 董文培, Jason Wadjaja, 等. 单孔腹腔镜胃袖状切除术265例临床分析. 中国实用外科杂志, 2024, 44(8): 906-910.
19. 王亮, 张璇, 李震, 等. 脐内2 cm小切口单孔腹腔镜胃袖状切除术8例体会. 中国微创外科杂志, 2018, 18(11): 993-996.
20. Widjaja J, Yang J, Dong W, et al. Single-port one anastomosis sleeve gastrectomy with transit bipartition: initial experience and technique. Obes Surg, 2024, 34(7): 2739-2743.
21. Yang J, Widjaja J, Wang R, et al. Routine gastric suspension technique in single-port sleeve gastrectomy procedure. Surg Endosc, 2023, 37(12): 9651-9657.
22. Morales-Conde S, Peeters A, Meyer YM, et al. European Association for Endoscopic Surgery (EAES) consensus statement on single-incision endoscopic surgery. Surg Endosc, 2019, 33(4): 996-1019.
23. Lainas P, Derienne J, Zervaki S, et al. Left hypochondrium or transumbilical single-incision laparoscopic sleeve gastrectomy for the treatment of severe obesity: surgical technique and results of a tertiary referral bariatric center. Obes Surg, 2021, 31(11): 5063-5070.
24. Stefanopoulos A, Economopoulos KP, Kalles V. Single incision laparoscopic sleeve gastrectomy: a review. Obes Surg, 2015, 25(8): 1502-1510.
25. Tranchart H, Rebibo L, Gaillard M, et al. Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis. Surgical Endoscopy, 2020, 34(9): 3978-3985.Tranchart H, Rebibo L, Gaillard M, et al. Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis. Surgical Endoscopy, 2020, 34(9): 3978-3985.
26. Huang CK. Single-incision laparoscopic bariatric surgery. J Minim Access Surg, 2011, 7(1): 99-103.

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