The Three Incision Laparoscopic Sleeve (TILS) Technique: A Less Invasive Approach to Gastric Sleeve Surgery

Louisiana Valenzuela, MD, FACS — Wed, 28 Aug 2024 19:10:33 +0000

As a bariatric surgeon who has dedicated my career to helping patients achieve their weight loss goals, I have always been driven by a commitment to provide the safest, most effective, and least invasive surgical options available. The laparoscopic gastric sleeve has long been the most popular metabolic surgery for weight loss around the world. This popularity has allowed us to continuously refine and perfect the technique, resulting in better outcomes for patients. I’m excited to share with you one of the latest advancements that I have embraced in my practice – the Three Incision Laparoscopic Sleeve (TILS).

The Evolution of Weight Loss Surgery

Over the years, I have seen bariatric surgery evolve significantly. The increasing number of surgeries performed and the extensive experience gained by surgeons have allowed us to continually improve, simplify, and enhance the techniques we use. With each surgery, I aim to deliver the best possible outcome, always looking for ways to make the procedure safer and more comfortable for my patients. This is where the TILS technique comes into play. With TILS, we are moving beyond the traditional approach of using multiple incisions. Instead, we perform the surgery using just three small incisions. This method is designed to maximize aesthetic benefits while reducing the risks of complications such as port-site bleeding, post-surgical hernias, pain, and lengthy recovery times. Additionally, TILS allows for quicker mobilization after surgery, which is crucial in preventing complications like blood clots, lung collapses, bleeding, hernias, or intestinal paralysis (ileus) due to limited movement.¹

Why I Choose the TILS Technique for My Patients

I believe that every patient deserves a tailored approach to weight loss surgery, one that is customized to their unique needs and goals. The TILS technique represents a significant advancement in minimally invasive surgery, offering numerous benefits that align with my philosophy of patient-centered care.

Better Cosmetic Results: When patients come to me for surgery, I understand that the aesthetic outcome is often a major concern. With TILS, the three small incisions are less visible, resulting in minimal scarring and a better overall cosmetic outcome. This allows my patients to enjoy their new bodies without the constant reminder of their surgery.
Reduced Pain and Faster Recovery: One of the key advantages of the TILS approach is that it results in significantly less pain compared to the traditional five-incision technique. With fewer entry points, there is less trauma to the tissue, which leads to a more comfortable recovery and allows patients to resume their daily activities more quickly.
Lower Risk of Complications: The fewer incisions we make, the lower the chances of complications such as bleeding, infections, or hernias. TILS also eliminates the need for post-surgical drains, which further reduces the risk of infection and enhances patient comfort.
Quicker Return to Normal Activity: With TILS, patients are able to move around more freely and comfortably shortly after surgery. This rapid mobilization is essential in preventing serious complications such as blood clots, lung issues, and intestinal problems. The sooner my patients are up and moving, the better their overall recovery and outcome.

Who Can Benefit from the TILS Technique?

As with any surgical procedure, it is important to determine who the ideal candidates are. I typically recommend the TILS technique for patients with a Body Mass Index (BMI) ranging from 30 to 50. Several factors play a role in deciding if this approach is suitable:

Liver Size: A well-prepared liver is crucial for the minimally invasive approach of TILS. I work with my patients to follow a specific preoperative diet that helps shrink the liver, making it easier to navigate during surgery.
Presence of Hiatal Hernia: Patients without a hiatal hernia, or those with a small, manageable one, are excellent candidates for TILS.
Previous Surgeries and Adhesions: If a patient has minimal or no abdominal adhesions from prior surgeries, TILS may be the best option.

My Approach to the TILS Technique

When I perform the TILS procedure, I make three small incisions in the abdomen. Through these incisions, I insert a laparoscope, a small camera that allows me to visualize the stomach and surrounding structures. Using specialized surgical instruments, I carefully reshape the stomach into a sleeve-like structure, reducing its size by about 80%. This not only limits the amount of food the patient can consume but also decreases the production of the hunger hormone, ghrelin, helping them feel full faster and for longer periods.

Why I Don’t Use Drains with TILS

Another aspect of the TILS technique that I advocate for is the elimination of post-surgical drains. Traditionally, drains are used to remove fluid from the surgical site, but they can also be a source of discomfort, infection, and longer hospital stays.^2,³ By not using drains, my patients experience less pain, have a lower risk of infection, and are able to recover more quickly.

The Results I Have Seen with TILS

Over the years, I have performed countless TILS procedures, and the outcomes have been consistently positive. My patients report:

Improved aesthetics with minimal scarring.
Reduced pain and fewer instances of nausea.
Proper respiratory function, reducing the risk of lung collapses.
Rapid mobilization, preventing complications such as blood clots and intestinal issues.
Lower risk of hernias and reduced bleeding sites.

These results reaffirm my belief that TILS is not only a safer and more effective procedure but also one that aligns with my goal of providing the best possible care to my patients.

Your Journey Towards a Healthier You Starts Here

If you are considering weight loss surgery and are looking for a less invasive option with faster recovery and better aesthetic outcomes, the TILS technique might be right for you. I encourage you to take the first step by submitting your health questionnaire or joining our Facebook support group. Our community is filled with patients who have undergone the TILS procedure and are eager to share their experiences and support you in your journey.

At Do It Bariatrics, we are committed to providing you with the information, support, and care you need to achieve your weight loss goals. Together, we can help you become the best version of yourself.

References:

Stier, C., Chen, W., Chong, T. H., Yang, J., Parmar, C., & Wang, C. (2021). Step-By-Step Instructions For The Innovative Three-Port-Technique of Laparoscopic Sleeve Gastrectomy: How I Do It?.
Aragone, L., Thibaud, F., Tóffolo, M., Mihura, M., & Pirchi, D. E. (2024). Abdominal Drains After Laparoscopic Sleeve Gastrectomy: Should They Be Used?. Journal of metabolic and bariatric surgery, 13(1), 27–33. https://doi.org/10.17476/jmbs.2024.13.1.27
Nedelcu M, Manos T, Noel P, Danan M, Zulian V, Vilallonga R, Nedelcu A, Carandina S. Is the Surgical Drainage Mandatory for Leak after Sleeve Gastrectomy? J Clin Med. 2023 Feb 9;12(4):1376. doi: 10.3390/jcm12041376. PMID: 36835912; PMCID: PMC9963979.

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