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banding, gastric sleeve does not interfere with absorption of food, medication or vitamins. On average, patients lose 50-70 percent of their excess body weight. Single incision laparoscopic surgery (SILS) is considered to be one of the greatest advances in minimally invasive surgery in the last few years. As indicated by its name, SILS involves a single inci- sion 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." The SILS approach to adjustable gastric Roux-en-Y Gastric Bypass banding and gastric sleeve has been successfully performed by Dr. Saber and Dr. Khaitan. In fact, Dr. Saber is credited with performing the first SILS gastric sleeve. "SILS is considered an enhancement of laparoscopic surgery in that multiple ports are reduced to one small single port. Patients usually have only a one-night stay in the hospital and the potential for less pain and faster recovery time and return to normal activities," says Dr. Khaitan. "Because there's no visible scar, there's better cosmesis and privacy — no one will know you had surgery," adds Dr. Saber. "This contributes to higher self esteem and improved body image." Another exciting frontier in bariatric Adjustable Gastric Banding surgery involves the use of a robotic sur- gery system for bariatric surgery. Excess fatty tissue can often make surgery more complicated. With the surgical robot, however, the 3D high-definition imaging and improved surgical precision can make bariatric surgery easier for the surgeon and easier on the patient. "The robot gives the surgeon the advantage of better visualization and dexterity," says Dr. Saber, who points out that the robotic system is ideal for the gastric sleeve procedure. "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 Gastric Sleeve human hands. And the 3D visualization and magnification of the surgical site allows the surgeon to really see the depth of the structures." Recently, Dr. Khaitan was involved in investigating an endoscopic weight loss procedure referred to as a transoral (through the mouth) sleeve gastro- plasty. Techniques are being perfected to perform incisionless bariatric surgery through the mouth on an outpatient basis, as well. Several other endoscopic treatments for bariatric surgery are also being investigated. Battle Strategies Both Dr. Khaitan and Dr. Saber emphasize the importance of pre- and post-operative patient education and support. Prospective patients have the opportunity to attend free informa- tional seminars, while new patients are carefully evaluated to determine their eligibility for weight loss surgery and the best procedure relative to expected outcomes, long-term health and cosmesis. After surgery, patients are provided with an ongoing range of other criti- cal services, including counseling, nutritional services, exercise therapy and 24-hour access to the bariatric team. Ongoing support groups are also offered monthly at four conveniently located UH facilities, providing patients the opportunity to learn from their peers, as well as from physicians and staff who appear as guest speakers to address issues such as how to deal with excess skin after significant weight loss. "At UH we do everything we can to set up our patients for success," says Dr. Saber. "And we have a lot of patient success stories," adds Dr. Khaitan. "Weight loss is not easy, but it is a battle that can be won. And we can help." For more information about bariatric surgery at University Hospitals, visit www.UHhospitals.org/weightlossinfo. ■ ILLUSTRATIONS COURTESY OF UNIVERSITY HOSPITALS, CLEVELAND