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Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass

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Abstract

Background

Traditional laparoscopic surgery presents some difficulties for morbidly obese patients due to limited motion of instruments related to a thick abdominal wall, intraabdominal fat, and a large hepatic left lobe, with consequent loss of dexterity and greater musculoskeletal discomfort. Robotic technique could potentially overcome these limitations. This study aimed to evaluate robot-assisted laparoscopic Roux-en-Y gastric bypass in morbidly obese patients and to compare the results of robotic assistance with those of traditional laparoscopic technique.

Methods

Between September 2006 and June 2009, 110 morbidly obese patients underwent laparoscopic Roux-en-Y gastric bypass with robot-assisted hand-sewn gastrojejunal anastomosis using the da Vinci Surgical System. The data for these patients was compared with the data for 423 consecutive patients treated in a standard laparoscopic manner during the same period.

Results

The patients had a mean preoperative age of 42.6 years, a mean weight of 127.5 kg, and a mean body mass index (BMI) of 46.7 kg/m2. The total mean operative time was 247.5 min. The robotic setup time was 10.1 min, and the robotic operative time was 54.5 min. The conversion rate was nil. The intraoperative complication rate was 4.5%. The early and late major postoperative complication rates were 3.6 and 6.4% respectively. The cost per patient was 5777.76 €. For the standard laparoscopy, the operative time was significantly shorter (187 min; p < 0.001), and the costs per patient were significantly lower (4658.28 €; p < 0.001), whereas no differences were found in terms of the intra- or postoperative complication rates, revisional surgery, or hospital length of stay.

Conclusions

Although safe and intuitive, the robotic approach was burdened by a longer operative time and higher equipment costs. Moreover, it did not seem to provide a real advantage over standard laparoscopy in terms of hospital length of stay and complications rates.

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Disclosures

Gitana Scozzari, Fabrizio Rebecchi, Paolo Millo, Stefano Rocchietto, Rosaldo Allieta, and Mario Morino have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General Surgery and Center for Minimal Invasive Surgery, University of Torino, C.so AM Dogliotti, 14, 10126, Torino, Italy

    Gitana Scozzari, Fabrizio Rebecchi, Stefano Rocchietto & Mario Morino

  2. Department of General Surgery, Regional Hospital “Umberto Parini”, Aosta, Italy

    Paolo Millo & Rosaldo Allieta

Authors
  1. Gitana Scozzari
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  2. Fabrizio Rebecchi
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  3. Paolo Millo
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  4. Stefano Rocchietto
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  5. Rosaldo Allieta
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  6. Mario Morino
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Correspondence to Mario Morino.

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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 25, 597–603 (2011). https://doi.org/10.1007/s00464-010-1229-1

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