ABSTRACT: Application of the robot for Roux-en-Y gastric bypass has been slow to evolve, despite its rapid acceptance in other fields. This is largely due to associated costs of technology, reports of increased operative time, and inadequate data available to correlate the benefits of robotics to a clinical outcome. The authors present a comparative study between laparoscopic and robot-assisted Roux-en-Y gastric bypass performed at a specialized institution for robotic surgery.
A total of 135 consecutive Roux-en-Y gastric bypass procedures were performed from January 2006 to December 2009 by a single surgeon. The first 45 were performed laparoscopically and the remaining 90 were robot-assisted. Patient demographics, operative time, complication rate, length of stay, long-term weight loss, and follow-up for the two groups were gathered from a prospectively maintained database and statistically analyzed.
The overall operative time was significantly shorter for the robot-assisted procedures than for the laparoscopic procedures (207 ± 31 vs. 227 ± 31 min) (P = 0.0006). The robotic set-up time remained constant at 13 ± 4 min. 30 robotic cases were necessary in order to perform the procedure in less time than with the laparoscopic approach (P = 0.047). Mortality was 0% in both groups, with no conversions to open surgery and no transfusions. Early morbidities and percentage of excess weight loss at 1 year were comparable for the two groups.
The use of the robot for performing the gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass does not increase the operative time or the rate of specific complications. The short-term outcomes of the robot-assisted procedure are comparable to those found with the conventional laparoscopic method.
World Journal of Surgery 03/2011; 35(3):637-42. · 2.36 Impact Factor
ABSTRACT: Roux-en-Y gastric bypass performed laparoscopically remains the gold standard in bariatric surgery. The role of robot-assisted laparoscopic Roux-en-Y gastric bypass has not been clearly defined.
We present 80 consecutive cases of robot-assisted laparoscopic Roux-en-Y gastric bypass performed at a single institution. Mechanics, early outcomes, and learning curve are evaluated. Eighty robot-assisted laparoscopic Roux-en-Y gastric bypasses were performed on 71 women and 9 men with a mean age of 39 years, mean preoperative weight of 134 kg, and mean BMI of 48.
Total mean operative time was 209 minutes. There was no mortality, leak, stricture, or obstruction.
Robot-assisted laparoscopic Roux-en-Y gastric bypass is a safe and feasible option for bariatric surgery. Its role in improving surgical outcomes needs to be defined further.
Journal of Laparoendoscopic & Advanced Surgical Techniques 12/2010; 20(10):847-50. · 1.40 Impact Factor
ABSTRACT: Use of robotic surgery has gained increasing acceptance over the last few years. There are few reports, however, on advanced pancreatic robotic surgery. In fact, the indication for robotic surgery in pancreatic disease has been controversial. This paper retrospectively reviews one surgeon's experience with robotic surgery to treat pancreatic disease, and analyzes its indications and outcomes, as well as the controversy that exists.
A retrospective review of the charts of all patients who underwent robotic surgery for pancreatic disease by a single surgeon at two different institutions was carried out.
From October 2000 to January 2009, 134 patients underwent robotic-assisted surgery for different pancreatic pathologies. All procedures were performed using the da Vinci robotic system. Of the 134 patients, 83 were female. The average age of all patients was 57 years (range 24-86 years). Mean operating room (OR) time was 331 min (75-660 min). There were 14 conversions to open surgery. Mean length of stay was 9.3 days (3-85 days). Length of stay for patients with no complications was 7.9 days (3-15 days). The postoperative morbidity rate was 26% and the mortality rate was 2.23% (three patients). Among the procedures performed were 60 pancreaticoduodenectomies, 23 spleen-preserving distal pancreatectomies, 23 splenopancreatectomies, 3 middle pancreatectomies, 1 total pancreatectomy, and 3 enucleations. Another 21 patients underwent different surgical procedures for treatment of acute and chronic pancreatitis. Two cases of pancreaticoduodenectomy were performed in outside institutions and are not included in this series.
This is the largest series of robotic pancreatic surgery presented to date. Robotic surgery enables difficult technical maneuvers to be performed that facilitate the success of pancreatic minimally invasive surgery. The results in this series demonstrate that it is feasible and safe. Complication and mortality rates are comparable to those of open surgery but with the advantages of minimally invasive surgery.
Surgical Endoscopy 07/2010; 24(7):1646-57. · 4.01 Impact Factor