552 Evaluating Trocar Placement Variability and Its Influence on Outcomes in Laparoscopic Bariatric Surgery

Abstract

Abstract Aim This study investigates the variability in trocar site placement during laparoscopic sleeve gastrectomy (LSG) and its impact on key outcomes, including operative time and excess weight loss percentage (EWL%). The goal is to identify factors influencing patient outcomes. Method A systematic review and meta-analysis of 34 studies involving 7,173 LSG cases were conducted. Variables assessed included trocar numbers, placements, manipulation angles, patient demographics, and clinical outcomes like operative time and EWL% at 6, 12, and 24 months. Statistical analyses examined the correlation between trocar configurations and surgical efficiency, using intraoperative images to estimate angles. Results Significant variability in port configurations was observed across studies. EWL% outcomes ranged from 39.90% (seven ports) to 60.80% (six ports) at 6 months, with similar trends at 12 and 24 months. Operative times were not significantly related to manipulation angles or port numbers. Mean manipulation angles were 83.05 ± 25.89°, with azimuth angles of 45.32° and 44.39° for the right and left sides. Variations in port placement and angles reflected the lack of standardized approaches across settings. Conclusions Variability in trocar site placement during LSG significantly impacts EWL%. While operative times remain unaffected by port configurations, optimizing trocar positioning could improve outcomes. Further research is needed to establish standardized guidelines for port placement in bariatric surgery.