Rationale:
Sleeve gastrectomy is the most frequent surgery performed worldwide in bariatric surgery. In recent years, there has been an increase in the tendency to perform this procedure using a single port; however, to date, there have been no reports of this magnet-assisted surgery. We developed a magnet-assisted sleeve gastrectomy technique to demonstrate the use of magnets in different steps of the surgery to perform this procedure.
Patient Concerns:
A 38-year-old woman with a body mass index of 36.2 kg/m2 attended the clinic with the desire to lose weight in order to improve her living conditions.
Diagnosis:
Based on her weight and height, the patient's body mass index was diagnosed as obese grade II. During the examination by the multidisciplinary team, the patient presented with a blood pressure of 133/86 mm Hg and was diagnosed with hypertension.
Intervention:
The sleeve gastrectomy technique was performed in a standard manner using a single port located in the umbilicus and a 5-mm port in the right upper quadrant. In addition, we used a magnet positioned on the outside of the patient's abdomen, and a grasper coupled to a magnet was positioned in different parts of the cavity to assist in different steps of the surgery.
Outcomes:
The surgery was successfully completed with no intraoperative complications with the use of magnetic devices. The patient was discharged 36 hours postoperatively with nutritional indications. At the month follow-up the patient lost 7 kg of initial weight.
Lessons:
The use of a novel magnetic device can achieve a greater degree of ease in the face of difficulties associated with single-port sleeve gastrectomy.
Background
Pipeline Embolisation Device (PED) is a flow diversion stent for the treatment of large wide neck aneurysms that are not well treated with coiling methods including stent assisting coiling. The PED material and design are relatively unique including its deployment.
Objective
Evaluation of the PED procedures including issues during deployment and strategies to outcome problems.
Methods
Retrospective multicentreed case series of 30 PED procedures for treatment of aneurysms. The cases were evaluated for issues that arose during PED deployment. The different strategies for managing problems was assessed for their effectiveness.
Results
There were eight major issues with PED deployment. 1. Detachment from capture coil, 2. PED apposition to the vessel wall, 3. Torqueing or twisting of the PED, 4. Accurate placement of the PED, 5. Herniation of PED into aneurysm, 6. Advancing the microcatheter and removing the delivery system, 7. Accessing the distal outflow artery, and 8. Post procedure stroke within 3 days. Successful treatment strategies for each of the major issues demonstrated reasonable success.
Conclusion
PED is a 1st generation flow diversion stent with a variety of issues related to its deployment. However, familiarity with PED deployment strategies can result in a more successful deployment.
Disclosures
A. Urdaneta: None. R. Darflinger: None. K. Chao: None. L. Feng: None.
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