Current Trends in the Utilization of a Robotic Approach in the Field of Bariatric Surgery

Bauerle, Wayne B.; Mody, Pooja; Estep, Allison; Stoltzfus, Jill; Chaar, Maher El

doi:10.1007/s11695-022-06378-1

Cited by 25 publications

(8 citation statements)

References 14 publications

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“…The robotic approach to bariatric surgery has been growing at a fast pace in recent years with tripling of the amount of robotic SG and RYGB from 2015 to 2020. 66 Despite a longer operative time, studies have shown no significant difference in outcomes between robotic and laparoscopic approaches for bariatric surgery. 67 Even though a robotic approach does not necessarily improve outcomes, there are benefits that are harder to quantify such as improved visualization, improved instrument degrees of freedom, surgeon comfort, and ability to perform the procedure without a skilled surgical assistant.…”

Section: Future Considerationsmentioning

confidence: 99%

Updates in Bariatric Surgery

Hsu,

Farrell

2023

The American Surgeon™

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Bariatric surgery is currently the most effective long-term treatment for morbid obesity as well as type-2 diabetes mellitus. The field of metabolic and bariatric surgery has seen tremendous growth over the past decade with dramatically reduced risks. This article aims to provide an update on bariatric surgery, highlighting the latest outcomes, improvements, and challenges in the field. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) released a major update to the indications for bariatric surgery at BMI ≥35 kg/m2 regardless of co-morbidities and 30-34.9 kg/m2 with obesity-related comorbidities. Sleeve gastrectomy has emerged as the most popular bariatric procedure in the last 10 years with its remarkable efficacy and safety profile. The implementation of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and Enhanced Recovery After Surgery (ERAS) protocols have significantly improved the quality of care for all bariatric patients. The recent introduction and FDA approval of Glucagon-Like Peptide-1 (GLP-1) agonists for chronic obesity has garnered significant media coverage and popularity, but no guidelines exist regarding its use in relation to bariatric surgery. This update underscores the need for tailored approaches, ongoing research, and the integration of evidence-based medicine and innovations to enhance patient care.

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Section: Future Considerationsmentioning

confidence: 99%

Updates in Bariatric Surgery

Hsu,

Farrell

2023

The American Surgeon™

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“…While the nuances of selecting the surgical approach are outside the scope of this study, it is worth noting that laparoscopic procedures (with or without the surgical robot) are standard-of-care, and significant differences in postoperative morbidity among the three approaches have not been reliably demonstrated [40]. There is a trend towards increased utilization of the surgical robot, given the theoretical advantages of decreased tissue injury, improved wound healing, and augmented suturing dexterity [41]. The distribution of approaches in the present cohort is as follows: open, 5.0%; laparoscopic, 74.9%; robotic, 20.1%.…”

Section: Plos Onementioning

confidence: 99%

Late surgical start time is associated with increased blood transfusion following gastric bypass surgery

et al. 2023

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Background Surgical start time (SST) has demonstrated conflicting effects on perioperative outcomes due to confounding factors, such as increased acuity in later SST cases. This study investigated the effect of SST on blood transfusion after gastric bypass surgery, a complication-prone elective surgical procedure. Methods This retrospective cohort study included all patients undergoing gastric bypass surgery at a single academic medical center from 2016 through 2021 (n = 299). The primary independent variable was SST (before vs. after 15:00). The primary outcome was blood transfusion. Secondary outcomes included postoperative respiratory failure, length of stay, acute kidney injury, and mortality. The associations between SST and outcomes were investigated with univariate analyses. Multivariate and receiver operating characteristic (ROC) analyses were applied to the primary outcome, adjusting for demographic and operative characteristics. Results On univariate analysis, 15:00–18:43 SST was associated with an increased risk of blood transfusion (relative risk 4.32, 95% confidence interval 1.27 to 14.63, p = 0.032), but not postoperative respiratory failure, acute kidney injury, length of stay, or mortality. On multivariate analysis, the only independent predictor of postoperative blood transfusion was a 15:00–18:43 SST (adjusted odds ratio 4.32, 95% confidence interval 1.06 to 15.96, c-statistic = 0.638). ROC analysis demonstrated that compared to the 15:00 threshold, a 14:34 threshold predicted postoperative blood transfusion with better accuracy (sensitivity = 70.0%, specificity = 83.0%). Conclusions Despite having similar demographic and operative characteristics, gastric bypass patients in the late SST cohort had a greater incidence of postoperative blood transfusion in this single-center study.

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“…Consequently, the working space and exposure is limited, while torque forces are amplified ( 4 , 5 ). In addition, the further preference for hand-sewn anastomosis construction, has steered several bariatric surgeons towards the more ergonomic robotic solutions ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

“…The first robotic-assisted bariatric procedure was performed in 1998 by Cadiere for gastric banding ( 8 ), soon followed by a robotic-assisted RYGB (RRYGB) ( 9 ). Since then, proportions of RRYGB operations performed, utilizing the Da Vinci platform (Intuitive Surgical, Sunnyvale, CA, USA), have steadily increased, reaching a percentage of 16.7 by 2020 in the U.S. ( 7 ). RRYGB has been associated with lower rates of complications but longer operative times and higher costs when compared to laparoscopic RYGB (LRYGB) in meta-analyses ( 3 , 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Roux-en-Y Gastric Bypass with the novel robotic platform HUGO™ RAS

et al. 2023

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IntroductionRobotic assisted surgery is a rapidly developing field of minimally invasive bariatric surgery in the last 20 years. Its wide diffusion has led to the development and standardization of robotic assisted approaches for bariatric operations. In this study, we present the first four Roux-en-Y Gastric Bypass (RYGB) operations performed with the new Hugo™ RAS system (Medtronic, Minneapolis, MN, USA).MethodsIn January and February 2023, 4 consecutive patients scheduled for minimal invasive Roux-en-Y-Bypass were selected and underwent the procedure robotic-assisted with the new platform. No exclusion criteria were applied.ResultsFour patients, two females and two males, underwent RYGB with a median BMI of 40 Kg/m2 (range: 36–46) and diabetes mellitus in two cases. The median docking time was 8 min (range: 7–8.5) and the median console time was 127.5 min (range: 95–150). A description of the operating theatre, robotic arms and docking setup is provided. Procedures were performed without intraoperative complications and no conversion to laparoscopy or open surgery was noted. No additional ports were needed to be placed. System's function and docking were uneventful. No early post-operative complications were observed.ConclusionsBased on our initial experience, RYGB with the Hugo™ RAS system is feasible. This study provides the configurations necessary to perform RYGB with the Hugo™ RAS system as well as general information and insights from our preliminary experience.

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Current Trends in the Utilization of a Robotic Approach in the Field of Bariatric Surgery

Cited by 25 publications

References 14 publications

Updates in Bariatric Surgery

Updates in Bariatric Surgery

Late surgical start time is associated with increased blood transfusion following gastric bypass surgery

Feasibility of Roux-en-Y Gastric Bypass with the novel robotic platform HUGO™ RAS

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