The number of laparoscopic bariatric surgical procedures is rapidly increasing all over the world, as it has the advantage of improving recovery time and reducing surgical morbidity. Laparoscopic bariatric procedures require appropriate equipment and instrumentation and surgeons are required to have advanced surgical skills.
The operating room must be equipped with an adequate bed with a capacity of approximately 400 kg which makes it possible to safely position an obese patient and prevent musculoskeletal injuries.
For bariatric procedures is essential:
Optical devices: preferably a 30 or 45 degree telescope, provided with a white light illumination source and a video camera of high resolution. A TV monitor is required for reproduction of endoscopic images and the 4K monitors are recommendable. A DVD recorder allows for documentation of procedures performed.
Equipment to creatine / maintain the domain: For performing laparoscopy is necessary a high flow CO2 insufflator which can deliver up 20 liters/min, to maintain a level of 12-15mmHg.
Instruments for access: the Veress needle is commonly used, it should be appropriate for the size of the abdominal wall.
Operative instruments:
Trocars: available in various diameters and sizes according to requirements.
Graspers: Bullet nose grasper and Dorsey intestinal fenestrated grasper are the most commonly used and are completely atraumatic.
Dissectors: like Maryland and bipolar dissector.
Scissors: Hook scissors or dissecting scissors with diathermy are used as required.
Bowel and lung clamps: they are not frequently used, but are useful in revision procedures.
Energy sources: There’s currently a shift towards the use of bipolar instead of monopolar in bariatric surgery.
Tissue approximation/ hemostasis:
Laparoscopic ligating suture delivery system
Needle driver
Clip applicators
Mechanical stapling devices: completely changed the bariatric surgery. A range of staple lengths (2.5-3.8mm) is available depending on the thickness of the tissue to be divided.
Miscellaneous: like aspiration/irrigation probes or organ extraction devices.
It is also important to set a bariatric unit with adequate entrances and routes, lobbies and waiting areas for obese patients, appropriate bedrooms and bathrooms to improve the quality of attention for these patients.
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