Totally Robotic Roux-en-Y Gastric Bypass

Mohr, Catherine; Nadzam, Geoffrey; Curet, Myriam J.

doi:10.1001/archsurg.140.8.779

Cited by 101 publications

(97 citation statements)

References 16 publications

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“…The greatest advantages reported by these surgeons included articulating wrists, three-dimensional view, motion scaling for precise hand movement, and mechanical forces to counteract the abdominal wall torque. Altogether, these advantages not only could improve clinical results of the RYGBP but also could shorten the learning curve for this procedure [12]. In the 2003 survey by Jacobsen et al [10], surgeons who had experience with more than 20 cases reported that the setup and operative times were inversely proportional to the number of operative cases performed.…”

Section: Discussionmentioning

confidence: 99%

“…In the recent literature, several reports of robot-assisted RYGBP have been published [9,10,[28][29][30][31][32]34]. Most of these report robotic assistance used only in the creation of the gastrojejunostomy, whereas only a few authors have described a totally robotic RYGBP [12,[35][36][37]. The current study was conducted in two surgical units devoted largely to laparoscopic and bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

“…We start with placement of six ports, all 10-or 12-mm Ethicon trocars (Ethicon Endosurgery, Cincinnati, OH, USA). We use the double-cannulation technique [12], with the da Vinci ports placed inside conventional laparoscopic Ethicon ports. During the laparoscopic portion of the procedure, a 100-cm Roux-en-Y limb is created.…”

Section: Surgical Techniquementioning

confidence: 99%

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Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass

et al. 2010

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Background Traditional laparoscopic surgery presents some difficulties for morbidly obese patients due to limited motion of instruments related to a thick abdominal wall, intraabdominal fat, and a large hepatic left lobe, with consequent loss of dexterity and greater musculoskeletal discomfort. Robotic technique could potentially overcome these limitations. This study aimed to evaluate robot-assisted laparoscopic Roux-en-Y gastric bypass in morbidly obese patients and to compare the results of robotic assistance with those of traditional laparoscopic technique. Methods Between September 2006 and June 2009, 110 morbidly obese patients underwent laparoscopic Roux-en-Y gastric bypass with robot-assisted hand-sewn gastrojejunal anastomosis using the da Vinci Surgical System. The data for these patients was compared with the data for 423 consecutive patients treated in a standard laparoscopic manner during the same period. Results The patients had a mean preoperative age of 42.6 years, a mean weight of 127.5 kg, and a mean body mass index (BMI) of 46.7 kg/m 2 . The total mean operative time was 247.5 min. The robotic setup time was 10.1 min, and the robotic operative time was 54.5 min. The conversion rate was nil. The intraoperative complication rate was 4.5%. The early and late major postoperative complication rates were 3.6 and 6.4% respectively. The cost per patient was 5777.76 €. For the standard laparoscopy, the operative time was significantly shorter (187 min; p < 0.001), and the costs per patient were significantly lower (4658.28 €; p < 0.001), whereas no differences were found in terms of the intra-or postoperative complication rates, revisional surgery, or hospital length of stay. Conclusions Although safe and intuitive, the robotic approach was burdened by a longer operative time and higher equipment costs. Moreover, it did not seem to provide a real advantage over standard laparoscopy in terms of hospital length of stay and complications rates. Keywords Bariatric surgery Gastrojejunal anastomosis Morbid obesity Robot-assisted gastric bypass Robotic surgery Roux-en-Y gastric bypass To date, bariatric surgery is the only long-term effective therapy available for the morbidly obese population [1][2][3]. Over recent decades, laparoscopic surgical techniques have become the gold standard in bariatric surgery due to advantages such as less postoperative pain, shorter hospital stay, faster postoperative recovery, and minimal scarring [4][5][6]. Moreover, for the obese patient, the mini-invasive approach has demonstrated its ability to reduce postoperative mortality [7,8]. However, the inherent limitations of traditional laparoscopic surgery may cause some technical difficulties due to the limited freedom of motion for the instruments related to the thick abdominal wall and hepatomegaly, with consequent loss of dexterity and greater musculoskeletal discomfort for the surgeon [9].

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass

et al. 2010

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“…11 In several similar studies learning curve was found to be significantly shorter. 12,13 The learning-curve terminology is contributed to the literature of Ramsay et al during the 2000s.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Robotic Surgery and the Learning Curve

Erdemır¹,

Uygur²

2015

Turkiye Klinikleri J Urology

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Robotic surgery is a method that has been increasingly performed recently and provides a lot of convenience for the surgeon. Thirty-four prostatectomy cases performed between 2011-2013 were evaluated to share the experiences of our center related to the factors affecting robotic surgery and the evaluation of the learning curve. M Ma at te er ri ia al l a an nd d M Me et th h--o od ds s: : The cases were divided into five groups, namely: the first fifteen (Group 1a) and the last fifteen (Group 1b) cases; cases with a history of laparotomy (Group 2a, n:22) and those without history of laparotomy (Group 2b, n:12), cases with no postoperative drainage (Group 3a, n:27) and those with postoperative drainage (Group 3b, n:7); those with single operative assistant port (Group 4a, n:26) and those with double operative assistant port (Group 4b, n:8); cases with body mass index (BMI) of over 25 (overweight-obese) (Group 5a, n:27) and those with BMI of under 25 (normal weight, Group 5b, n:7); first seven (Group 6a), second seven (Group 6b), third seven (Group 6c) and last seven (Group 6d). The groups were evaluated according to the trocar time, docking time, console time, bleeding amount, specimen weight, comorbidity, incontinence and surgical margin parameters. R Re es su ul lt ts s: : In our study, it was determined that the learning curve began to build up after case fifteen, and that comorbidities, previous laparotomy, size of the prostate and obesity did not negatively affect the operation, and placing a drainage tube was not beneficial. C Co on nc cl lu us si io on n: : Obesity was determined to be an increasing factor for the bleeding during robotic surgery.K Ke ey y W Wo or rd ds s: : Robotics; learning curve; prostatic neoplasms Ö ÖZ ZE ET T A Am ma aç ç: : Robotik cerrahi gün geçtikçe kullanımı artan, cerraha birçok kolaylık sağlayan bir yöntemdir. Robotik cerrahiyi etkileyen faktörler ve öğrenme eğrisinin değerlendirilmesi yö-nünden merkezimizin tecrübelerini paylaşmak için, 2011-2014 yılları arasında yaptığımız otuzdört prostatektomi olguları değerlendirilmiştir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Olgular beş gruba ayrılmış olup, ilk onbeş (Grup 1a) ve son onbeş (Grup 1b) olgular; özgeçmişinde laparotomi olmayan (Grup 2a, n:22) ve laparotomisi olan (Grup 2b, n:12); ameliyat sonunda dren konmayan (Grup 3a, n:27) ve konan (Grup 3b, n:7); asistan portu olarak tek (Grup 4a, n:26) ve çift port kullanılan (Grup 4b n:8); beden kitle indeksi 25 in üzerinde (kilolu-obez) olan (Grup 5a, n:27) ve altında olan (normal kilolu, Grup 5b, n:7); ilk yedi (Grup 6a), ikinci yedi (Grup 6b), üçüncü yedi (Grup 6c) ve son yedi (Grup 6d) olarak altı gruba ayrılmıştır. Gruplar trokar süresi, docking sü-resi, konsol süresi, kanama miktarı, spesmen ağırlığı, komorbidite, inkontinans ve cerrahi sınır parametreleri ile değerlendirilmiştir. B Bu ul lg gu ul la ar r: : Çalışmamızda öğrenme eğrisinin, onbeşinci vakadan sonra oluşmaya başladığı, komorbiditenin, geçirilmi...

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“…However, in parameters such as total operative time, robotic surgery seems to be advantageous 22,17,4,6 . In robotic surgical technique, this time can be divided in three different steps: 1) total operative time, from the start of the abdomen insufflation to the skin suture; 2) docking time, concerning preparation and coupling of the robot to the trocars; and 3) console time, which is the time the surgeon actually stays performing the distant surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

Resultados iniciais da primeira série de casos brasileira de cirurgia bariátrica totalmente robótica

Ramos

Domene

Volpe

et al. 2013

ABCD, arq. bras. cir. dig.

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-Background: Currently, bariatric surgery is the most effective therapy for morbid obesity, and the laparoscopic approach is considered gold-standard for Rouxen-Y gastric bypass. Totally robotic Roux-en-Y gastric bypass has been proposed as a major evolution in minimally invasive bariatric surgery and its use is becoming more widespread. Aim: To provide an early report of the first Brazilian case-series of totally robotic gastric bypass and perioperative short-term outcomes. There was no mortality, leak or stricture. Conclusion: Even with surgeons in early learning curves, the robotic approach within a well-structured training model was safe and reproducible for the surgical treatment of the morbid obesity. RESUMO -Racional:Atualmente a cirurgia bariátrica é o tratamento mais eficaz para a obesidade mórbida. Embora ainda tenha algumas dificuldades, a abordagem laparoscópica tem-se tornando o padrão-ouro para o by-pass gástrico em Y-deRoux. O uso da robótica representa grande evolução no campo da cirurgia bariátrica minimamente invasiva e seu uso tem sido cada vez mais difundido. Objetivo: Relatar a primeira experiência brasileira em cirurgia bariátrica totalmente robótica. Métodos: Foram avaliados todos os pacientes submetidos à cirurgia bariátrica totalmente robótica em dois centros de excelência em cirurgia bariátrica. Foram registrados a incidência demográfica, índice de massa corporal, tempos operatórios, duração da internação hospitalar, mortalidade e todas as complicações em até 30 dias. As equipes cirúrgicas receberam treinamento específico para aprendizagem da técnica robótica e todos os procedimentos foram feitos com supervisão. Resultados: O procedimento foi realizado por cinco equipes cirúrgicas em 68 pacientes (52 mulheres -76,5%), com idade média de 40,5 anos e IMC médio de 41,3. O tempo médio operatório total foi de 158 minutos e a média de permanência hospitalar foi de 48 h. O percentual de complicações perioperatórias foi de 5,9%. Não houve mortalidade, fístulas ou estenoses. Conclusão: Mesmo com cirurgiões em período inicial da curva de aprendizagem, o by-pass gástrico por abordagem totalmente robótica é opção técnica segura e reproduzível no tratamento cirúrgico da obesidade mórbida, desde que respeitado modelo de treinamento bem estruturado.

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Totally Robotic Roux-en-Y Gastric Bypass

Cited by 101 publications

References 16 publications

Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass

Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass

Factors Affecting Robotic Surgery and the Learning Curve

Resultados iniciais da primeira série de casos brasileira de cirurgia bariátrica totalmente robótica

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