Journal of Robotic Surgery

, Volume 2, Issue 3, pp 159–163

Lowering gastrointestinal leak rates: a comparative analysis of robotic and laparoscopic gastric bypass

  • Brad E. Snyder
  • Todd Wilson
  • Terry Scarborough
  • Sherman Yu
  • Erik B. Wilson
Original Article

Abstract

Robotic-assisted surgery has been described for many general surgery procedures, including gastric bypass. This is a comparative study looking at the short-term outcomes and technical differences between laparoscopic Roux-en-Y gastric bypass (LRNY) and robotic-assisted Roux-en-Y gastric bypass (RARNY). Our database was reviewed for all Roux-en-Y gastric bypass procedures performed over the last 5 years. Operative times, length of stay, and all complications listed for the 90 days postoperatively were recorded and statistically analyzed. A total of 356 LRNY and 249 RARNY were performed. The average body mass index (BMI), age, and sex were similar between groups. On average, the RARNY took 17 min longer than the LRNY, this difference being significant (p < 0.01). Average length of stay for the two groups was similar (~3 days). There were a total of 51 complications in the standard laparoscopic group (14%), of which 14 (3.9%) were major complications. In the robotic group, there were 35 (14%) complications, of which 9 (3.6%) were major complications. The only significant difference in complication rate was for anastomotic leak at the gastrojejunostomy: there were no leaks in the robotic series, and six (1.7%) in the standard laparoscopic series (p = 0.04). Length of stay and overall complication rates were similar for RARNY and LRNY. There was no mortality in either group, and the complication rate was lower than literature standards. While the RARNY took longer, there was a significantly lower gastrointestinal leak rate in this group.

Keywords

Leak rate Laparoscopic Roux-en-Y gastric bypass Robotic-assisted surgery Bariatric surgery 

References

  1. 1.
    Huffmanm LC, Pandalai PK, Boulton BJ, James L, Starnes SL, Reed MF et al (2007) Robotic Heller myotomy: a safe operation with higher postoperative quality-of-life indices. Surgery 142(4):613–618. doi:10.1016/j.surg.2007.08.003. Discussion 618–620PubMedCrossRefGoogle Scholar
  2. 2.
    Mohr CJ, Nadzam G, Curet M (2005) Totally robotic roux-en-Y gastric bypass. Arch Surg 140:779–786. doi:10.1001/archsurg.140.8.779 PubMedCrossRefGoogle Scholar
  3. 3.
    Jacobsen G, Berger R, Horgan S (2003) The role of robotic surgery in morbid obesity. J Laparoendosc Adv Surg Tech A 13:279–284. doi:10.1089/109264203322333610 PubMedCrossRefGoogle Scholar
  4. 4.
    Kernstine KH, DeArmond DT, Shamoun DM, Campos JH (2007) The first series of completely robotic esophagectomies with three-field lymphadenectomy: initial experience. Surg Endosc 21(12):2285–2292. doi:10.1007/s00464-007-9405-7 PubMedCrossRefGoogle Scholar
  5. 5.
    Anderson C, Ellenhorn J, Hellan M, Pigazzi A (2007) Pilot series of robot-assisted laparoscopic subtotal gastrectomy with extended lymphadenectomy for gastric cancer. Surg Endosc 21(9):1662–1666. doi:10.1007/s00464-007-9266-0 PubMedCrossRefGoogle Scholar
  6. 6.
    Davol P, Sumfest J, Rukstalis D (2006) Robotic-assisted laparoscopic retroperitoneal lymph node dissection. Urology 67(1):199. doi:10.1016/j.urology.2005.07.022 PubMedCrossRefGoogle Scholar
  7. 7.
    Wu JC, Wu HS, Lin MS, Huang MH (2005) Robotic-assisted laparoscopic adrenalectomy. J Formos Med Assoc 104(10):748–751PubMedGoogle Scholar
  8. 8.
    Partin AW, Adams JB, Moore RG, Kavoussi LR (1995) Complete robot-assisted laparoscopic urologic surgery: a preliminary report. J Am Coll Surg 181(6):552–557PubMedGoogle Scholar
  9. 9.
    Moser F, Horgan S (2004) Robotically assisted bariatric surgery. Am J Surg 188(4):38S–44SPubMedCrossRefGoogle Scholar
  10. 10.
    Ali MR, Bhaskerrao B, Wolfe BM (2005) Robot-assisted laparoscopic roux-en-Y gastric bypass. Surg Endosc 19(4):468–472. doi:10.1007/s00464-004-8705-4 PubMedCrossRefGoogle Scholar
  11. 11.
    Horgan S, Galvani C, Gorodner MV, Omelanczuck P, Elli F, Moser F et al (2005) Robotic-assisted Heller myotomy versus laparoscopic Heller myotomy for the treatment of esophageal achalasia: multicenter study. J Gastrointest Surg 9:1020–1030. doi:10.1016/j.gassur.2005.06.026 PubMedCrossRefGoogle Scholar
  12. 12.
    Gonzalez R, Lin E, Venkatesh KR, Bowers SP, Smith CD (2003) Gastrojejunostomy during laparoscopic gastric bypass: analysis of three techniques. Arch Surg 138(2):181–184. doi:10.1001/archsurg.138.2.181 PubMedCrossRefGoogle Scholar
  13. 13.
    Capella JF, Capella RF (1999) Gastro-gastric fistulas and marginal ulcers in gastric bypass procedures for weight reduction. Obes Surg 9(1):22–27. doi:10.1381/096089299765553674 PubMedCrossRefGoogle Scholar
  14. 14.
    Iselin C, Fateri F, Caviezel A, Schwartz J, Hauser J (2007) [Usefullness of the Da Vinci robot in urologic surgery]. Rev Med Suisse 5(3):2766–2768Google Scholar
  15. 15.
    Marecik SJ, Chaudhry V, Jan A, Pearl RK, Park JJ, Prasad LM (2007) A comparison of robotic, laparoscopic, and hand-sewn intestinal sutured anastomoses performed by residents. Am J Surg 193(3):349–355. doi:10.1016/j.amjsurg.2006.09.018 PubMedCrossRefGoogle Scholar
  16. 16.
    Vidovszky TJ, Smith W, Ghosh J, Ali MR (2006) Robotic cholecystectomy: learning curve, advantages, and limitations. J Surg Res 136(2):172–178. doi:10.1016/j.jss.2006.03.021 PubMedCrossRefGoogle Scholar
  17. 17.
    McLeod IK, Mair EA, Melder PC (2005) Potential applications of the da Vinci minimally invasive surgical robotic system in otolaryngology. Ear Nose Throat J 84(8):483–487PubMedGoogle Scholar
  18. 18.
    Karamanoukian RL, Finley DS, Evans GR, Karamanoukian HL (2006) Feasibility of robotic-assisted microvascular anastomoses in plastic surgery. J Reconstr Microsurg 22(6):429–431. doi:10.1055/s-2006-947697 PubMedCrossRefGoogle Scholar
  19. 19.
    Katz RD, Rosson GD, Taylor JA, Singh NK (2005) Robotics in microsurgery: use of a surgical robot to perform a free flap in a pig. Microsurgery 25(7):566–569. doi:10.1002/micr.20160 PubMedCrossRefGoogle Scholar
  20. 20.
    Byrn JC, Schluender S, Divino CM, Conrad J, Gurland B, Shlasko E et al (2007) Three-dimensional imaging improves surgical performance for both novice and experienced operators using the da Vinci robot system. Am J Surg 193(4):519–522. doi:10.1016/j.amjsurg.2006.06.042 PubMedCrossRefGoogle Scholar
  21. 21.
    Munz Y, Moorthy K, Dosis A, Hernandez JD, Bann S, Bello F et al (2004) The benefits of stereoscopic vision in robotic-assisted performance on bench models. Surg Endosc 18(4):611–616. doi:10.1007/s00464-003-9017-9 PubMedCrossRefGoogle Scholar
  22. 22.
    Nezhat C, Saberi NS, Shahmohamady B, Nezhat F (2006) Robotic-assisted laparoscopy in gynecological surgery. JSLS 10(3):317–320PubMedGoogle Scholar
  23. 23.
    Renda A, Vallancien G (2003) Principles and advantages of robotics in urologic surgery. Curr Urol Rep 4(2):114–118. doi:10.1007/s11934-003-0037-8 PubMedCrossRefGoogle Scholar
  24. 24.
    Yu SC, Clapp BL, Lee MJ, Albrecht WC, Scarborough TK, Wilson EB (2006) Robotic assistance provides excellent outcomes during the learning curve for laparoscopic roux-en-Y gastric bypass: results from 100 robotic-assisted gastric bypasses. Am J Surg 192(6):746–749. doi:10.1016/j.amjsurg.2006.08.038 PubMedCrossRefGoogle Scholar
  25. 25.
    Higa KD, Boone KB, Ho T, Davies OG (2000) Laparoscopic roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg 135:1029–1033. doi:10.1001/archsurg.135.9.1029 PubMedCrossRefGoogle Scholar
  26. 26.
    Suggs WJ, Kouli W, Lupovici M, Chau WY, Brolin RE (2007) Complications at gastrojejunostomy after laparoscopic roux-en-Y gastric bypass: comparison between 21- and 25-mm circular staplers. Surg Obes Relat Dis 3(5):508–514. doi:10.1016/j.soard.2007.05.003 PubMedCrossRefGoogle Scholar
  27. 27.
    Matthews BD, Sing RF, DeLegge MH, Ponsky JL, Heniford BT (2000) Initial results with a stapled gastrojejunostomy for the laparoscopic isolated roux-en-Y gastric bypass. Am J Surg 179(6):476–481. doi:10.1016/S0002-9610(00)00393-7 PubMedCrossRefGoogle Scholar
  28. 28.
    Madan AK, Harper JL, Tichansky DS (2008) Techniques of laparoscopic gastric bypass: on-line survey of American Society for Bariatric Surgery practicing surgeons. Surg Obes Relat Dis 4(2):166–172PubMedCrossRefGoogle Scholar
  29. 29.
    Gonzalez R, Haines K, Gallagher SF, Murr MM (2006) Does experience preclude leaks in laparoscopic gastric bypass? Surg Endosc 20(11):1687–1692. doi:10.1007/s00464-004-8253-y PubMedCrossRefGoogle Scholar
  30. 30.
    Schweitzer MA, Lidor A, Magnuson TH (2006) A zero leak rate in 251 consecutive laparoscopic gastric bypass operations using a two-layer gastrojejunostomy technique. J Laparoendosc Adv Surg Tech A 16(2):83–87. doi:10.1089/lap.2006.16.83 PubMedCrossRefGoogle Scholar
  31. 31.
    Nguyen NT, Hinojosa M, Fayad C, Varela E, Wilson SE (2007) Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers. J Am Coll Surg 205(2):248–255. doi:10.1016/j.jamcollsurg.2007.03.011 PubMedCrossRefGoogle Scholar
  32. 32.
    Edwards MA, Jones DB, Ellsmere J, Grinbaum R, Schneider BE (2007) Anastomotic leak following antecolic versus retrocolic laparoscopic roux-en-Y gastric bypass for morbid obesity. Obes Surg 17(3):292–297. doi:10.1007/s11695-007-9048-8 PubMedCrossRefGoogle Scholar
  33. 33.
    Andrew CG, Hanna W, Look D, McLean AP, Christou NV (2006) Early results after laparoscopic roux-en-Y gastric bypass: effect of the learning curve. Can J Surg 49(6):417–421PubMedGoogle Scholar

Copyright information

© Springer-Verlag London Ltd 2008

Authors and Affiliations

  • Brad E. Snyder
    • 1
  • Todd Wilson
    • 1
  • Terry Scarborough
    • 1
  • Sherman Yu
    • 1
  • Erik B. Wilson
    • 1
  1. 1.The University of Texas Medical School at HoustonHoustonUSA

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