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Effectiveness and feasibility of robotic gastric neurostimulator placement in patients with refractory gastroparesis

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Abstract

Gastric neurostimulation (GNS) with Enterra® therapy device (Medtronic, Minneapolis, MN) appears as the last resort for patients with refractory gastroparesis. Currently, the device has Humanitarian Use status by Food and Drug Administration, thereby requiring further investigation. We aim to describe its feasibility and clinical outcomes using robotic technique. From June 2014 to September 2016, 15 consecutive patients underwent robotic insertion of Enterra® device. Patient demographics, comorbidities, and clinical outcomes including mortality, length of stay, readmission rates, reoperation and complications were retrospectively collected. Patients were also assessed based on a validated 14-point questionnaire regarding satisfaction with the operation, quality of life and symptomatic relief. Mean age was 41.6 years ± 13.8 and there were 11 females (73.3%). No mortality was reported. The annual hospital admissions were reduced after GNS (2.5 ± 4.1 vs. 3.6 ± 4.4, p = 0.004). The frequency of bloating (p = 0.029) and severity of emesis (p = 0.038), early satiety (p = 0.042) and bloating (p = 0.031) were reduced after GNS. The severity and frequency total scores were also improved after GNS (12.6 ± 1.4 vs. 18.1 ± 2.7, p = 0.008 and 12.9 ± 2.2 vs. 16.1 ± 1.1, p = 0.016, respectively). This is the first report describing the clinical experience with robotic insertion of GNS device. This approach is safe and feasible and seems to have similar long-term outcomes as laparoscopic technique. Potential advantages to robotic technique include enhanced dexterity and suturing of the device within gastric wall. Further experience with large prospective studies and randomized clinical trials may be warranted.

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Authors and Affiliations

  1. Department of Surgery, Providence Hospital and Medical Centers, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI, 48075, USA

    Mia Mowzoon, Francisco Igor B. Macedo, Jaskiran Kaur & Ramachandra Kolachalam

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  1. Mia Mowzoon
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  2. Francisco Igor B. Macedo
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  3. Jaskiran Kaur
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  4. Ramachandra Kolachalam
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Correspondence to Francisco Igor B. Macedo.

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The authors (Mowzoon M, Macedo FI, Kaur J and Kolachalam R) declare no conflict of interest to disclose.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institution Review Board at Providence Hospital and Medical Centers/Michigan State University College of Human Medicine and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Mowzoon, M., Macedo, F.I.B., Kaur, J. et al. Effectiveness and feasibility of robotic gastric neurostimulator placement in patients with refractory gastroparesis. J Robotic Surg 12, 303–310 (2018). https://doi.org/10.1007/s11701-017-0732-y

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  • DOI: https://doi.org/10.1007/s11701-017-0732-y

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