Advertisement

Essentials and Future Directions of Robotic Bariatric Surgery

  • Shinil K. ShahEmail author
  • Peter A. Walker
  • Brad E. Snyder
  • Erik B. Wilson
Chapter

Abstract

As the epidemic of obesity and related health issues continues to increase, the field of bariatric surgery has exploded. Almost all bariatric procedures are now performed with the assistance of minimally invasive techniques, and the adoption of robotics in this field continues to increase. We review the literature and data surrounding the application of robotics in adjustable gastric band, sleeve gastrectomy, roux-en-y gastric bypass, biliopancreatic diversion/duodenal switch, revisional bariatric surgery, and bariatric surgery in the pediatric population. In addition, we also discuss training and port placement and present several videos of robotic bariatric surgical procedures. As the literature on robotics in bariatric surgery continues to mature, the appropriate application of robotics in this field continues to evolve.

Keywords

Bariatric Surgery Gastric Bypass Sleeve Gastrectomy Laparoscopic Sleeve Gastrectomy Biliopancreatic Diversion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 6.1

Robotic-assisted sleeve gastrectomy: Video demonstrates a representative robotic-assisted sleeve gastrectomy. The greater curvature and fundus are fully mobilized from about 5 cm from the pylorus to the angle of His. The sleeve is created over a 34 French orogastric sizing tube. Staple line reinforcements are used with each staple load (MOV 75153 kb)

316165_1_En_6_MOESM2_ESM.mov (182.5 mb)
Video 6.2 Robotic-assisted roux-en-y gastric bypass: Totally robotic roux-en-y gastric bypass. The gastrojejunostomy fashioned is started followed by creation of the jejunojejunostomy (stapled anastomosis followed by hand-sewn closure of the enterotomy). The mesenteric defect is closed after completion of the jejunojejunostomy. The remaining of the gastrojejunostomy is completed. This is a totally robotic procedure performed with one assistant port for introduction and firing of the staplers (MOV 186907 kb)
Video 6.3

Robotic-assisted revision of adjustable gastric band to roux-en-y gastric bypass: Video demonstrates an example of revisional bariatric surgery. The band is initially removed followed by creation of the gastric pouch. After removal of the band, the gastric bypass is then performed in a similar manner to the primary gastric bypass. The small bowel is ran from the ligament of Treitz for about 50–75 cm and brought up to the pouch. In the procedure video shown, the back outer row (running Lembert sutures) of the gastrojejunostomy was placed followed by transection of the small bowel to separate the roux and biliopancreatic limbs. The roux limb was run for 100–150 cm, and the jejunojejunostomy was created with a stapled common channel and hand-sewn closure of the enterotomy. The mesenteric defect was closed and the remainder of the gastrojejunostomy was completed (2-layered hand-sewn anastomosis over an approximately 15 mm sizing tube). The two layered gastrojejunostomy can be completed prior to division of the jejunum and creation of the jejunojejunostomy. Classically, in the laparoscopic procedure, the jejunojejunostomy is created first followed by the gastrojejunostomy. Reversing this with the robotic technique allows for a rapid and sequential natural progression of the operation (MOV 136245 kb)

References

  1. 1.
    Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the US. Int J Obes (Lond). 2013;37(6):889–91.CrossRefGoogle Scholar
  2. 2.
    Moshiri M, Osman S, Robinson TJ, et al. Evolution of bariatric surgery: a historical perspective. AJR. 2013;201(1):W40–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia The diabetes surgery study randomized clinical trial. JAMA. 2013;309(21):2240–9.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomized controlled trials. BMJ. 2013;347:f5934.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190. 215–357.CrossRefGoogle Scholar
  6. 6.
    Batchelder AJ, Williams R, Sutton C, Khanna A. The evolution of minimally invasive bariatric surgery. J Surg Res. 2013;183:559–66.PubMedCrossRefGoogle Scholar
  7. 7.
    Cadiere GB, Himpens J, Vertruyen M, et al. The world’s first obesity surgery performed by a surgeon at a distance. Obes Surg. 1999;2:206–9.CrossRefGoogle Scholar
  8. 8.
    Ben-or S, Nifong LW, Chitwood WR. Robotic surgical training. Cancer J. 2013;19(2):120–3.PubMedCrossRefGoogle Scholar
  9. 9.
    Liss MA, McDougall EM. Robotic surgical simulation. Cancer J. 2013;19(2):124–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Ayloo S, Fernandes E, Choudhury N. Learning curve and robot set-up/operative times in singly docked totally robotic Roux-en-y gastric bypass. Surg Endosc 2014; Published ahead of print.Google Scholar
  11. 11.
    Wilson EB, Bagshahi H, Woodruff VD. Chapter 10: robotic roux-en-Y gastric bypass. In: Kim KC, editor. Robotics in general surgery. New York: Springer Science + Business Media; 2014.Google Scholar
  12. 12.
    Nguyen NT, Nguyen B, Gehbart A, Hohmann S. Changes in the makeup of bariatric surgery: a national increase in use of laparoscopic sleeve gastrectomy. J Am Coll Surg. 2013;216(2):252–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Edelson PK, Dumon KR, Sonnad SS, et al. Robotic vs. conventional laparoscopic gastric banding: a comparison of 407 cases. Surg Endosc. 2011;25(5):1402–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Diamantis T, Alexandrou A, Nikitteas N, et al. Initial experience with robotic sleeve gastrectomy for morbid obesity. Obes Surg. 2011;21:1172–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Ayloo S, Buchs NC, Addeo P, et al. Robot-assisted sleeve gastrectomy for super-morbidly obese patients. J Laparoendosc Adv Surg Tech A. 2011;21(4):295–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Vilallonga R, Fort JM, Caubet E, et al. Robotic sleeve gastrectomy versus laparoscopic sleeve gastrectomy: a comparative study with 200 patients. Obes Surg. 2013;23:1501–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Romero RJ, Kosanovic R, Rabaza JR, et al. Robotic sleeve gastrectomy: experience of 134 cases and comparison with a systematic review of the laparoscopic approach. Obes Surg. 2013;23(11):1743–52.PubMedCrossRefGoogle Scholar
  18. 18.
    Vilallonga R, Fort JM, Gonzalez O, et al. The initial learning curve for robot-assisted sleeve gastrectomy: a surgeon’s experience while introducing the robotic technology in a bariatric surgery department. Minim Invasive Surg. 2012;2012:347131.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Rezvani M, Sucandy I, Antanavicius G. Totally robotic stapleless vertical sleeve gastrectomy. Surg Obes Relat Dis. 2013;9(5):e79–81.PubMedCrossRefGoogle Scholar
  20. 20.
    Mohr CJ, Nadzam GS, Curet MJ. Totally robotic roux-en-y gastric bypass. Arch Surg. 2005;140(8):779–86.PubMedCrossRefGoogle Scholar
  21. 21.
    Parini U, Fabozzi M, Contul RB, et al. Laparoscopic gastric bypass performed with the Da Vinci Intuitive Robotic System: preliminary experience. Surg Endosc. 2006;20(120):1851–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Diamantis T, Alexandrou A, Gouzis K, et al. Early experience with totally robotic roux-en-y gastric bypass for morbid obesity. J Laparoendosc Adv Surg Tech A. 2010;20(10):797–801.PubMedCrossRefGoogle Scholar
  23. 23.
    Ayloo SM, Addeo P, Buchs NC, et al. Robot-assisted versus laparoscopic roux-en-y gastric bypass: is there a difference in outcomes? World J Surg. 2011;35(3):637–42.PubMedCrossRefGoogle Scholar
  24. 24.
    Park CW, Lam EC, Walsh TM, et al. Robotic-assisted roux-en-y gastric bypass performed in a community hospital setting: the future of bariatric surgery? Surg Endosc. 2011;25(10):3312–21.PubMedCrossRefGoogle Scholar
  25. 25.
    Snyder BE, Wilson T, Leong BY, et al. Robotic-assisted roux-en-y gastric bypass: minimizing morbidity and mortality. Obes Surg. 2010;20(3):265–70.PubMedCrossRefGoogle Scholar
  26. 26.
    Tieu K, Allison N, Snyder B, et al. Robotic-assisted roux-en-y gastric bypass: update from 2 high-volume centers. Surg Obes Relat Dis. 2013;9(2):284–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Markar SR, Karthikesalingam AP, Venkat-Ramen V, et al. Robotic vs. laparoscopic roux-en-y gastric bypass in morbidly obese patients: systematic review and pooled analysis. Int J Med Robot. 2011;7(4):393–400.PubMedCrossRefGoogle Scholar
  28. 28.
    Sudan R, Puri V, Sudan D. Robotically assisted biliary pancreatic diversion with a duodenal switch: a new technique. Surg Endosc. 2007;21:729–33.PubMedCrossRefGoogle Scholar
  29. 29.
    Mohr CJ, Nadzam GS, Alami RS, et al. Totally robotic laparoscopic roux-en-y gastric bypass: results from 75 patients. Obes Surg. 2006;16(6):690–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Buchs NC, Pugin F, Bucher P, et al. Learning curve for robot-assisted roux-en-y gastric bypass. Surg Endosc. 2012;26(4):1116–21.PubMedCrossRefGoogle Scholar
  31. 31.
    Ayloo S, Fernandez E, Choudhury N. Learning curve and robot set-up/operative times in singly docked totally robotic roux-en-y gastric bypass. Surg Endosc. 2014;28(5):1629–33.PubMedCrossRefGoogle Scholar
  32. 32.
    Sanchez BR, Mohr CJ, Morton JM, et al. Comparison of totally robotic laparoscopic Roux-en-y gastric bypass and traditional laparoscopic roux-en-y gastric bypass. Surg Obes Relat Dis. 2005;1(6):549–54.PubMedCrossRefGoogle Scholar
  33. 33.
    Yu SC, Clapp BL, Lee MJ, et al. 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. 2006;192(6):746–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Sudan R, Bennett KM, Jacobs DO, Sudan DL. Multifactorial analysis of the learning curve for robot-assisted laparoscopic biliopancreatic diversion with duodenal switch. Ann Surg. 2012;255(5):940–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Scozzari G, Rebecchi F, Millo P, et al. Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic roux-en-y gastric bypass. Surg Endosc. 2011;25(2):597–603.PubMedCrossRefGoogle Scholar
  36. 36.
    Bailey JG, Hayden JA, Davis PJ, et al. Robotic versus laparoscopic roux-en-y gastric bypass (RYGB) in obese adults ages 18–65 years: a systematic review and economic analysis. Surg Endosc. 2014;28(2):414–26.PubMedCrossRefGoogle Scholar
  37. 37.
    Hagen ME, Pugin F, Chassot G, et al. Reducing cost of surgery by avoiding complications: the model of robotic roux-en-y gastric bypass. Obes Surg. 2012;22(1):52–61.PubMedCrossRefGoogle Scholar
  38. 38.
    Snyder B, Wilson T, Woodruff V, Wilson E. Robotically assisted revision of bariatric surgeries is safe and effective to achieve further weight loss. World J Surg. 2013;37(11):2569–73.PubMedCrossRefGoogle Scholar
  39. 39.
    Buchs NC, Pugin F, Azagury DE, et al. Robotic revisional bariatric surgery: a comparative study with laparoscopic and open surgery. Int J Med Robot 2013; 2013 Oct 24. doi:  10.1002/rcs.1549. [Epub ahead of print]
  40. 40.
    Shimizu H, Annaberdyev S, Motomarry I, et al. Revisional bariatric surgery for unsuccessful weight loss and complications. Obes Surg. 2013;23(11):1766–73.PubMedCrossRefGoogle Scholar
  41. 41.
    Alqahtani A. Robotic gastric banding in children and adolescents: a comparative study. Surg Endosc. 2011;25:3647–51.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Shinil K. Shah
    • 1
    Email author
  • Peter A. Walker
    • 1
  • Brad E. Snyder
    • 1
  • Erik B. Wilson
    • 1
  1. 1.Department of SurgeryUniversity of Texas Medical School at HoustonHoustonUSA

Personalised recommendations