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: 3.75). 11/2009; 20(3):265-70. DOI: 10.1007/s11695-009-0012-7
Source: PubMed


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.

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    • "was willing to consider the robotic-assisted approach to potentially reduce these issues. There have been several reported series of at least 100 robotic-assisted Roux-en-Y gastric bypass procedures678910. All were hybrid operations with varying amounts of the operation performed laparoscopically, although each procedure involved a robotically assisted, hand-sewn gastrojejunostomy . "
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    ABSTRACT: Background: Roux-en-Y gastric bypass is an effective treatment for severe obesity and obesity-related comorbidities. Presently, gastric bypass is performed most often laparoscopically, although a robotic-assisted procedure is the preferred approach for an increasing number of bariatric surgeons. Methods: This retrospective study compared the results of 100 Roux-en-Y gastric bypass operations using the da Vinci robot and 100 laparoscopic Roux-en-Y gastric bypasses performed laparoscopically. Short-term outcomes were determined by evaluating mortality, length of stay, length of operation, return to the operating room within 90 days of operation, conversions to open procedure, leaks, strictures, transfusions, and hospital readmissions. Results: There was no mortality, pulmonary embolus, or conversion to open procedure in either group. Both the laparoscopic and robotic operative times decreased progressively, although the robotic operation time was longer (mean, 144 versus 87 min, P < 0.001). The length of stay was shorter for the robotic-assisted group (37 versus 52 h, P < 0.001), and 60% of these patients were discharged after one night's stay (P < 0.001). There were fewer transfusions (P = 0.005) and readmissions (P = .560) in the robotic group. The stricture rate was higher in the first 50 robotic procedures (17 mm gastrotomy) but resolved in the second 50 procedures (21 mm gastrotomy). There was no difference in the rate of leak and return to the operating room between groups (both P > 0.05). Conclusions: These results indicate that Roux-en-Y gastric bypass can be performed safely with robotic assistance, even during the first 100 cases.
    No preview · Article · Jan 2013 · Obesity Surgery
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    • "In conclusion, the robotic approach to gastric bypass provides results similar (feasibility, morbidity) to those obtained by conventional laparoscopy. One study even shows a decreased risk of leakage of the gastrojejunal anastomosis [66]. This point remains to be confirmed by studies with a good level of evidence (I or II) [25]. "

    Full-text · Article · Oct 2011 · Journal of Visceral Surgery
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    • "Weight loss after robotic surgery is similar to that obtained in open or conventional laparoscopic surgery. However, morbidity and notably the risk of gastrojejunostomy leak may be reduced with robotic surgery [1] "

    Full-text · Article · Jun 2011 · Journal of Visceral Surgery
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