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Robot-assisted duodenal switch with DaVinci Xi: surgical technique and analysis of a single-institution experience of 661 cases

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Abstract

Metabolic and bariatric surgery is an effective treatment for the management of obesity and related comorbidities. Although the duodenal switch has demonstrated superior results in terms of resolution of obesity-related comorbidities and weight loss, it is one of the less performed procedures. The use of robotic surgical platforms offers many advantages in obese patients and is particularly useful in technically demanding procedures such as duodenal switch. Observational, retrospective and analytical study of cases corresponding to robot-assisted duodenal switch performed between 2016 and 2021. We describe our technique using the system DaVinci Xi. Operative and perioperative variables, postoperative complications, and readmission rate were determined. A total of 661 patients underwent duodenal switch which correspond to the 20.7% of the total bariatric procedures performed in this period. A clear decrease in surgical time and length of stay was observed as the number of cases progressively increased. The complication rate during the first 30 days was 9.1%. Among these, only 1.9% corresponded to major complications, being strictures the most frequent (0.9%), followed by leaks (0.45%). Readmission rate in this period was 6.1%. Between 30 and 90 days postoperatively, the complication rate was 0.91%. Robotic-assisted duodenal switch is a safe surgery with a low complication rate. This procedure is highly effective in terms of durable weight loss in obese and super-obese patients. Robotic DaVinci Xi system allows surgeons to achieve a high level of proficiency and master technique resulting in reduction of surgical time and length of stay.

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References

  1. Lin X, Li H (2021) Obesity: epidemiology, pathophysiology, and therapeutics. Front Endocrinol. https://doi.org/10.3389/fendo.2021.706978

    Article  Google Scholar 

  2. Mohammed MS, Sendra S, Lloret J, Bosch I (2018) Systems and WBANs for controlling obesity. J Healthc Eng 2018:1–21. https://doi.org/10.1155/2018/1564748

    Article  Google Scholar 

  3. Ozsoy Z, Demir E (2018) Which bariatric procedure is the most popular in the world? A bibliometric comparison. Obes Surg 28:2339–2352. https://doi.org/10.1007/S11695-018-3163-6

    Article  PubMed  Google Scholar 

  4. Jawad MA, Nelson L, Moon RC, Teixeira AF (2017) Robotic-assisted laparoscopic biliopancreatic diversion, vertical sleeve gastrectomy with traditional roux-en-y duodenal switch. Obes Surg 27:263–266. https://doi.org/10.1007/S11695-016-2412-9

    Article  PubMed  Google Scholar 

  5. Ozmen M, Gundogdu E, Guldogan E (2021) The current role of robotics in bariatric surgery. Minerva surg 76:24–32

    Article  PubMed  Google Scholar 

  6. Leal Ghezzi T, Campos Corleta O (2016) 30 Years of robotic surgery. World J Surg 40:2550–2557. https://doi.org/10.1007/s00268-016-3543-9

    Article  PubMed  Google Scholar 

  7. Al-Mazrou AM, Cruz MV, Dakin G et al (2021) Robotic duodenal switch is associated with outcomes comparable to those of laparoscopic approach. Obes Surg 31:2019–2029. https://doi.org/10.1007/s11695-020-05198-5

    Article  PubMed  PubMed Central  Google Scholar 

  8. Antanavicius G, Katsichtis T, Alswealmeen W, Assali M (2020) Three hundred four robotically assisted biliopancreatic diversion with duodenal switch operations with gradual robotic approach implementation: short-term outcomes, complication profile, and lessons learned. Obes Surg 30:3961–3967. https://doi.org/10.1007/s11695-020-04764-1

    Article  PubMed  Google Scholar 

  9. Moss EL, Sarhanis P, Ind T et al (2020) Impact of obesity on surgeon ergonomics in robotic and straight-stick laparoscopic surgery. J Minim Invasive Gynecol 27:1063–1069. https://doi.org/10.1016/j.jmig.2019.07.009

    Article  PubMed  Google Scholar 

  10. Teixeira A, Jawad M, Moon R (2019) Technique of robotic duodenal switch traditional and single anastomosis ilium duodenal switch. Bariatric Robot Surg. https://doi.org/10.1007/978-3-030-17223-7_12

    Article  Google Scholar 

  11. Hagen ME, Jung MK, Ris F et al (2017) Early clinical experience with the da Vinci Xi surgical system in general surgery. J Robot Surg 11:347–353. https://doi.org/10.1007/s11701-016-0662-0

    Article  PubMed  Google Scholar 

  12. Ngu J, Tsang C, Koh D (2017) The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery. Robot Surg 4:77–85. https://doi.org/10.2147/RSRR.S119317

    Article  PubMed  PubMed Central  Google Scholar 

  13. Nelson L, Moon RC, Texeira AF et al (2016) Safety and effectiveness of single anastomosis duodenal switch procedure: preliminary result from a single institution. Arq Bras Cir Dig 29:80–84. https://doi.org/10.1590/0102-6720201600s10020

    Article  PubMed Central  Google Scholar 

  14. O’Brien PE, Hindle A, Brennan L et al (2019) Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obes Surg 29:3–14. https://doi.org/10.1007/s11695-018-3525-0

    Article  PubMed  Google Scholar 

  15. Herrera L, Escalon J, Johnston M et al (2022) Development of a robot-assisted thoracic surgery (RATS) program. Lessons learned after 2500 cases. J Robot Surg. https://doi.org/10.1007/S11701-022-01430-9

    Article  PubMed  Google Scholar 

  16. Wang L, Yu Y, Wang J et al (2022) Evaluation of the learning curve for robotic single-anastomosis duodenal–ileal bypass with sleeve gastrectomy. Front Surg. https://doi.org/10.3389/fsurg.2022.969418

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ren CJ, Patterson E, Gagner M (2000) Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 10:514–523. https://doi.org/10.1381/096089200321593715

    Article  CAS  PubMed  Google Scholar 

  18. Biertho L, Lebel S, Marceau S et al (2013) Perioperative complications in a consecutive series of 1000 duodenal switches. Surg Obes Relat Dis 9:63–68. https://doi.org/10.1016/j.soard.2011.10.021

    Article  PubMed  Google Scholar 

  19. Vaz C (2019) Robotic bariatric surgery complications. Bariatric Robotic Surgery. https://doi.org/10.1007/978-3-030-17223-7_13

    Article  Google Scholar 

  20. Kim W (2003) Laparoscopic vs. open biliopancreatic diversion with duodenal switch a comparative study. J Gastrointest Surg 7:552–557. https://doi.org/10.1016/S1091-255X(02)00149-X

    Article  PubMed  Google Scholar 

  21. Yolsuriyanwong K, Ingviya T, Kongkamol C et al (2019) Effects of intraoperative leak testing on postoperative leak-related outcomes after primary bariatric surgery: an analysis of the MBSAQIP database. Surg Obes Relat Dis 15:1530–1540. https://doi.org/10.1016/j.soard.2019.06.008

    Article  PubMed  Google Scholar 

  22. Skogar ML, Sundbom M (2020) Early complications, long-term adverse events, and quality of life after duodenal switch and gastric bypass in a matched national cohort. Surg Obes Relat Dis 16:614–619. https://doi.org/10.1016/j.soard.2020.02.001

    Article  PubMed  Google Scholar 

  23. Antanavicius G, Rezvani M, Sucandy I (2015) One-stage robotically assisted laparoscopic biliopancreatic diversion with duodenal switch: analysis of 179 patients. Surg Obes Relat Dis 11:367–371. https://doi.org/10.1016/j.soard.2014.10.023

    Article  PubMed  Google Scholar 

  24. Sudan R, Podolsky E (2015) Totally robot-assisted biliary pancreatic diversion with duodenal switch: single dock technique and technical outcomes. Surg Endosc 29:55–60. https://doi.org/10.1007/s00464-014-3653-0

    Article  PubMed  Google Scholar 

  25. Roth AE, Thornley CJ, Blackstone RP (2020) Outcomes in bariatric and metabolic surgery: an updated 5-year review. Curr Obes Rp 9:380–389. https://doi.org/10.1007/s13679-020-00389-8

    Article  CAS  Google Scholar 

  26. Anthone GJ, Lord RVN, DeMeester TR, Crookes PF (2003) The Duodenal switch operation for the treatment of morbid obesity. Ann Surg 238:618–628. https://doi.org/10.1097/01.sla.0000090941.61296.8f

    Article  PubMed  PubMed Central  Google Scholar 

  27. McBride K, Steffens D, Stanislaus C et al (2021) Detailed cost of robotic-assisted surgery in the Australian public health sector: from implementation to a multi-specialty caseload. BMC Health Serv Res 21:108. https://doi.org/10.1186/s12913-021-06105-z

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sanchez A, Herrera L, Teixeira A et al (2022) Robotic surgery: financial impact of surgical trays optimization in bariatric and thoracic surgery. J Robot Surg. https://doi.org/10.1007/s11701-022-01412-x

    Article  PubMed  Google Scholar 

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Acknowledgements

Dr. Alexis Sanchez and Dr. Andre Teixeira have been proctors of Robotic Surgery and have received honoraria from Intuitive Surgical, Inc.

Funding

The authors declare no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Weight Loss and Bariatric Surgery Institute Orlando Health, Orlando, FL, USA

    Andre Teixeira, Muhammad Jawad & Muhammad Ghanem

  2. Robotic Surgery Program Orlando Health, Orlando, FL, USA

    Alexis Sanchez

  3. Robotic Surgery Program ORMC Orlando Health, 52 W Underwood St, Orlando, FL, USA

    Cristina Inchausti & Ivan Mogollon

  4. Weight Loss and Bariatric Surgery Institute Orlando Health, Orlando, FL, USA

    Romulo Lind

Authors
  1. Andre Teixeira
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  2. Muhammad Jawad
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  4. Alexis Sanchez
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  5. Cristina Inchausti
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  6. Ivan Mogollon
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  7. Romulo Lind
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Contributions

All the authors contributed to the study conception and design. Data preparation and analysis were performed by AS, RL, CI and IM. The first draft of the manuscript was written by AS, MG, CI and IM. All the authors commented on previous version of the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Ivan Mogollon.

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Teixeira, A., Jawad, M., Ghanem, M. et al. Robot-assisted duodenal switch with DaVinci Xi: surgical technique and analysis of a single-institution experience of 661 cases. J Robotic Surg 17, 923–931 (2023). https://doi.org/10.1007/s11701-022-01489-4

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