Abstract
Purpose
The purpose of this paper is to showcase a fully stapled approach to creating a gastrojejunostomy during a robot-assisted Roux-en-Y gastric bypass.
Methods
We utilize two robotic 12-mm ports, two robotic 8-mm ports, and one 8-mm assistant port. The tools used are a fenestrated bipolar forceps, vessel sealer, cadiere grasper, needle driver, and a robotic stapler. After the partial gastrectomy, the roux limb is brought up to the gastric pouch where monopolar scissors are used to create a gastrotomy and enterotomy. The gastrotomy is made just above the staple line of the gastric pouch. The enterotomy is created 2 cm distal to the roux limb’s staple line. The stapler is inserted into both the gastrotomy and enterotomy to create the common channel.
A 2–0 vicryl suture is used to place four interrupted sutures across the remaining enterotomy in full thickness bites. An endoscope or Visigi bougie is advanced across the anastomosis into the roux limb before the final suture. The tails of the most lateral and medial sutures are grasped and lifted towards the abdominal wall. The stapler is advanced over the approximated enterostomy while holding tension with the suture tails. The stapler is fired transversely across the suture line to seal the gastrojejunostomy. The staple line may be oversewn with silk sutures. A leak test is performed prior to completing the reconstruction with the jejunojejunostomy.
Conclusions
A fully stapled technique of anastomosis creation may reduce operative time, standardizes the process for reproducibility, and increases consistency across operators and patients.
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References
Rogula T, Koprivanac M, Janik MR et al (2018) Does robotic Roux-en-Y gastric bypass provide outcome advantages over standard laparoscopic approaches? Obes Surg 28(9):2589–2596. https://doi.org/10.1007/s11695-018-3228-6
Dolce CJ, Dunnican WJ, Kushnir L, Bendana E, Ata A, Singh TP (2009) Gastrojejunal strictures after Roux-en-Y gastric bypass with a 21-MM circular stapler. JSLS 13(3):306–311
Scarritt T, Hsu CH, Maegawa FB, Ayala AE, Mobily M, Ghaderi I (2021) Trends in utilization and perioperative outcomes in robotic-assisted bariatric surgery using the MBSAQIP database: a 4-year analysis. Obes Surg 31(2):854–861. https://doi.org/10.1007/s11695-020-05055-5
Dimou FM, Ackermann N, Chang SH, Freeman D, Eagon JC, Eckhouse SR (2021) Understanding the current role of robotic-assisted bariatric surgery. Obes Surg 31(7):3130–3137. https://doi.org/10.1007/s11695-021-05375-0
Senellart P, Saint-Jalmes G, Mfam WS, Abou-Mrad A (2020) Laparoscopic versus full robotic Roux-en-Y gastric bypass: retrospective, single-center study of the feasibility and short-term results. J Robot Surg 14(2):291–296. https://doi.org/10.1007/s11701-019-00976-5
Morrell ALG, Morrell-Junior AC, Morrell AG, Mendes JMF, Morrell AC (2021) Robotic Roux-en-Y gastric bypass: surgical technique and short-term experience from 329 cases. Rev Col Bras Cir 48:e20212982. https://doi.org/10.1590/0100-6991e-20212982 (Published 2021 Nov 29)
Lainas P, Kassir R, Benois M et al (2021) Comparative analysis of robotic versus laparoscopic Roux-en-Y gastric bypass in severely obese patients. J Robot Surg 15(6):891–898. https://doi.org/10.1007/s11701-020-01181-5
Reynvoet E, Van Vlodrop V, Hendrick K, Vandeweyer D, Vaz C (2021) Technical aspects and standardization of the totally robotic Roux-en-Y gastric bypass. Results of a single surgeon experience with a 5-year follow-up [published online ahead of print, 2021 Feb 18]. Acta Chir Belg: 1–11. https://doi.org/10.1080/00015458.2021.1889134
Ojima T, Nakamura M, Hayata K, Yamaue H (2020) Laparoscopic Roux-en-Y reconstruction using conventional linear stapler in robotic total gastrectomy for gastric cancer. Surg Oncol 33:9–10. https://doi.org/10.1016/j.suronc.2019.12.003
Aiolfi A, Tornese S, Bonitta G, Rausa E, Micheletto G, Bona D (2019) Roux-en-Y gastric bypass: systematic review and Bayesian network meta-analysis comparing open, laparoscopic, and robotic approach. Surg Obes Relat Dis 15(6):985–994. https://doi.org/10.1016/j.soard.2019.03.006
Kostakis ID, Sran H, Uwechue R et al (2019) Comparison between robotic and laparoscopic or open anastomoses: a systematic review and meta-analysis. Robot Surg 6:27–40. https://doi.org/10.2147/RSRR.S186768 (Published 2019 Dec 23)
Sharma G, Strong AT, Tu C, Brethauer SA, Schauer PR, Aminian A (2018) Robotic platform for gastric bypass is associated with more resource utilization: an analysis of MBSAQIP dataset. Surg Obes Relat Dis 14(3):304–310. https://doi.org/10.1016/j.soard.2017.11.018
Awad S, Aguilo R, Agrawal S, Ahmed J (2015) Outcomes of linear-stapled versus hand-sewn gastrojejunal anastomosis in laparoscopic Roux en-Y gastric bypass. Surg Endosc 29(8):2278–2283. https://doi.org/10.1007/s00464-014-3942-7
Chaouch MA, Kellil T, Taieb SK, Zouari K (2021) Barbed versus conventional thread used in laparoscopic gastric bypass: a systematic review and meta-analysis. Langenbecks Arch Surg 406(4):1015–1022. https://doi.org/10.1007/s00423-020-01979-9
De Jong A, Verzilli D, Geniez M, Chanques G, Nocca D, Jaber S (2018) Pourquoi le patient obèse morbide est-il un patient à risque anesthésique élevé ? [Why is the morbidly obese patient at high risk of anesthetic complications?]. Presse Med 47(5):453–463. https://doi.org/10.1016/j.lpm.2018.01.016
Jiang HP, Lin LL, Jiang X, Qiao HQ (2016) Meta-analysis of hand-sewn versus mechanical gastrojejunal anastomosis during laparoscopic Roux-en-Y gastric bypass for morbid obesity. Int J Surg 32:150–157. https://doi.org/10.1016/j.ijsu.2016.04.024
Bendewald FP, Choi JN, Blythe LS, Selzer DJ, Ditslear JH, Mattar SG (2011) Comparison of hand-sewn, linear-stapled, and circular-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Obes Surg 21(11):1671–1675. https://doi.org/10.1007/s11695-011-0470-6
Wiggins T, Majid MS, Markar SR, Loy J, Agrawal S, Koak Y (2020) Benefits of barbed suture utilisation in gastrointestinal anastomosis: a systematic review and meta-analysis. Ann R Coll Surg Engl 102(2):153–159. https://doi.org/10.1308/rcsann.2019.0106
Sundaresan N, Hiticas BA, Sullivan M et al (2021) Gastrojejunal anastomotic stricture following Roux-en-Y gastric bypass: an analysis of anastomotic technique at a single institution [published correction appears in Obes Surg. 2021 Sep 23;:]. Obes Surg 31(11):4947–4952. https://doi.org/10.1007/s11695-021-05678-2
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All authors have made substantive contributions, approved the final report, and endorsed the conclusions. LP: conceptualization, writing — original draft, writing — review and editing, visualization. MH: writing — original draft, writing — review and editing. SA: writing — original draft, writing — review and editing. JS: conceptualization, writing — review and editing, resources, methodology, supervision, project administration.
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Prager, L.P., Huff, M.L., Alfieri, S.E. et al. A fully stapled technique for gastrojejunal anastomosis creation in robotic Roux-en-Y gastric bypass. Langenbecks Arch Surg 407, 3311–3314 (2022). https://doi.org/10.1007/s00423-022-02634-1
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DOI: https://doi.org/10.1007/s00423-022-02634-1