Article

Robotic-Assisted Roux-en-Y Gastric Bypass: Minimizing Morbidity and Mortality

Department of Surgery, University of Texas Health Sciences Center at Houston, 6431 Fannin Street, Suite 4.294, Houston, TX, 77030, USA.
Obesity Surgery (Impact Factor: 3.74). 11/2009; 20(3):265-70. DOI: 10.1007/s11695-009-0012-7
Source: PubMed

ABSTRACT Despite the rapid acceptance of laparoscopic Roux-en-Y gastric bypass (RYGB) by the community and increase in the number of these procedures being done, there is still significant morbidity and mortality.
At the University of Texas Medical School at Houston, we have performed 320 RYGB with robotic assistance (RARYGB). Surgical times, length of stay, morbidity, and mortality have been recorded since the beginning of our robotic experience and represent the world's largest single institution series of RARYGB. Outcome data were examined in a postoperative cohort.
The average starting BMI was 49.1 kg/m(2), and it declined by 66% to 32.5 kg/m(2) by the end of 1 year. The average operative time was 192 min, and the average length of stay was 2.7 days. Within the first year, there were a total of 77 (24.1%) complications. The foremost complications noted in the literature to be 3% to 11% were all <1% in our series, and we have no mortalities. Compared to our 356 laparoscopic RYGB, there was a significantly lower gastrointestinal leak rate in the robotic arm. A cohort of 79 postoperative patients was analyzed with respect to weight loss, resolution of co-morbidity, and quality of life. While there was no variation in quality of life over time, weight loss, resolution of co-morbidities, and overall outcome score were significantly improved.
We effectively perform robotic-assisted RYGB that lowers the morbidity and mortality of this procedure compared to today's standard while maintaining thriving outcomes.

0 Bookmarks
 · 
99 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: With the rise in a number of bariatric procedures, surgeons are facing more complex and technically demanding surgical situations. Robotic digital platforms potentially provide a solution to better address these challenges. This review examines the published literature on the outcomes and complications of bariatric surgery using a robotic platform. Use of robotics to perform adjustable gastric banding, sleeve gastrectomy, roux-en-y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch and revisional bariatric procedures (RBP) is assessed. A search on PubMed was performed for the most relevant articles in robotic bariatric surgery. A total of 23 articles was selected and reviewed in this article. The review showed that the use of robotics led to similar or lower complication rate in bariatric surgery when compared with laparoscopy. Two studies found a significantly lower leak rate for robotic gastric bypass when compared to laparoscopic method. The learning curve for RYGB seems to be shorter for robotic technique. Three studies revealed a significantly shorter operative time, while four studies found a longer operative time for robotic technique of gastric bypass. As for the outcomes of RBP, one study found a lower complication rate in robotic arm versus laparoscopic and open arms. Most authors stated that the use of robotics provides superior visualisation, more degrees of freedom and better ergonomics. The application of robotics in bariatric surgery seems to be a safe and feasible option. Use of robotics may provide specific advantages in some situations, and overcome limitations of laparoscopic surgery. Large and well-designed randomised clinical trials with long follow-up are needed to further define the role of digital platforms in bariatric surgery.
    Journal of Minimal Access Surgery 01/2015; 11(1):16-21. DOI:10.4103/0972-9941.147673
  • [Show abstract] [Hide abstract]
    ABSTRACT: Sleeve gastrectomy has gained popularity over the past decade due to its safety, feasibility, and good results. The purpose of this study is to describe our results, both short and long term, with this procedure. This study is a nonrandomized, controlled, retrospective review of 409 patients who underwent a minimally invasive sleeve gastrectomy at the University of Illinois Hospital and Health System from January 2008 to December 2013. A total of 304 patients underwent a laparoscopic sleeve gastrectomy, and another 105 patients underwent a robotic procedure using the da Vinci Surgical System®. Patient demographics, comorbidities, date of surgery, postoperative morbidity and mortality, operating time, length of stay, and excess weight loss were reviewed. The mean age was 41 years (18-70) with no statistical difference between the two groups. Patient's demographics were similar (p = 0.395) in both groups. The mean operative time for the robotic group was 110.6 versus 84.18 min in the laparoscopic group, which was statistically significant (p < 0.05). There were no significant differences between the two groups with regard to the perioperative complications, length of stay, or % excess weight loss. There is no significant difference between the robotic and laparoscopic group in terms of complications, length of stay, and estimated blood loss. Robot-assisted sleeve gastrectomy is associated with longer operative time and increased cost.
    Obesity Surgery 11/2014; DOI:10.1007/s11695-014-1499-0 · 3.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Questo articolo passa in rassegna diversi interventi di chirurgia digestiva ed endocrina realizzati con l’aiuto del robot da Vinci®. Questi interventi sono stati oggetto di numerose pubblicazioni che dimostrano la fattibilità di questi gesti. Noi affrontiamo gli aspetti tecnici della chirurgia dell’acalasia, del reflusso gastroesofageo, del bypass gastrico, della resezione anteriore del retto, della rettopessi, delle resezioni pancreatiche e della surrenalectomia. Per ogni intervento, descriviamo la posizione del paziente, del carrello e dei trocar e le varie fasi chirurgiche. Le attuali pubblicazioni non dimostrano una superiorità dell’utilizzo di un’assistenza robotica paragonata alla laparoscopia convenzionale, ma la realizzazione di studi prospettici, comparativi e randomizzati dovrebbe permettere di giustificare il suo utilizzo. L’assistenza robotica permetterebbe di diffondere la pratica della chirurgia mini-invasiva facilitando la realizzazione di gesti che restano complessi in laparoscopia standard.
    09/2014; 20(3):1–8. DOI:10.1016/S1283-0798(14)68233-4