Essentials and Future Directions of Robotic Bariatric Surgery
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.
KeywordsBariatric Surgery Gastric Bypass Sleeve Gastrectomy Laparoscopic Sleeve Gastrectomy Biliopancreatic Diversion
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)
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)
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