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"The simplicity of the procedure and the decreased risk profile make gastric sleeve very appealing," says Dr. Saber. Single-Incision Bariatric Surgery Single incision laparoscopic surgery (SILS) is considered to be one of the great- est advances in minimally invasive surgery. As indicated by its name, SILS involves a single incision through which two or more ports for surgical tools are placed. The incision is usually in the umbilicus, so the scar is hidden, which is why SILS is often referred to as "scarless surgery." "Initially basic laparoscopic procedures such as cholecystectomy or appendec- tomy were done with this approach. Now more advanced laparoscopic procedures such as colorectal procedures and bariat- ric procedures are being done this way," says Dr. Khaitan, who reports that both adjustable gastric banding and the gastric sleeve procedure have been successfully performed by UH surgeons using the SILS approach. "Bariatric procedures are technically challenging — even when done with the traditional laparoscopic approach. The single incision approach requires even more unique surgical skills from the surgeon." Dr. Saber, who is credited with devel- oping the single-incision laparoscopic sleeve gastrectomy, agrees. "The single incision approach to bariatric surgery requires a certain set of surgical skills. In expert hands, it is safe and feasible and results in less postoperative pain, less need for analgesic, shorter hospital stay and quicker recovery than the conventional laparoscopic approach. Placing the incision inside the umbilicus, provides a better cosmetic result, as well." Robotic-Assisted Bariatric Surgery The newest frontier in bariatric sur- gery involves the use of a robotic surgery system for better visibility of anatomy and improved maneuverability of surgical instruments. According to Dr. Saber, excess fatty tissue can make surgery more complicated. The 3D high-definition The newest frontier for bariatric surgery involves the use of a robotic surgical system for better visibility of anatomy and improved maneuverability of surgical instruments. According to Dr. Alan Saber, who is one of the first in the area to perform robotic-assisted bariatric surgery, the robotic system is ideal for the gastric sleeve procedure. imaging and improved surgical precision which are the hallmarks of robotic surgical systems, however, can make bariatric surgery easier on the surgeon and the patient. "The robot gives the surgeon the advantage of better visualization and dexterity," says Dr. Saber, who was one of the first in the Cleveland area to perform robotic-assisted bariatric surgery. "The freedom of movement of the robotic wrists and endoscopic tools (which are operated by the surgeon from a control console in the surgery room) is even greater than that of human hands. And the 3D visualization and magnification of the surgical site allows the surgeon to really see the depth of the structures." According to Dr. Saber, the robotic system is ideal for the gastric sleeve procedure. "For patients with the right anatomy, this can be an excellent option." Each patient is carefully evaluated to determine which bariatric surgery will offer the best results for surgical success, long-term health and cosmetic outcome. When developing each patient's individualized plan of care, UH pulmo- nologists, cardiologists, endocrinologists and others may also be consulted. After surgery, patients are provided with an ongoing range of other critical services, including counseling, nutritional services and exercise therapy. "We have assembled a great team, all of whom have a lot of experience dealing with bariatric patients," says Dr. Khaitan. "And we feel that we can offer the highest level of personalized care here at UH." "We have seen tremendous growth in our program in recent years," says Dr. Saber. "The number of bariatric cases has tripled in the past three years, and we expect that number to continue to increase next year." Free informational seminars on options for surgical weight loss are held regularly across Northeast Ohio for prospective patients and their families. For upcoming dates and locations, visit UHhospitals.org/ weightlossinfo. ■ MARCH-APRIL 2012 n MDNEWS.COM n MD NEWS Cleveland-Akron-Canton | 37 PHOTOS COURTESY UNIVERSITY HOSPITALS