Vivek Bindal

Review of contemporary role of robotics in bariatric surgery

With the rise in a number of bariatric procedures, surgeons are facing more complex and technically demanding surgical situations. Robotic digital platforms potentially provide a solution to better address these challenges. This review examines the published literature on the outcomes and complications of bariatric surgery using a robotic platform. Use of robotics to perform adjustable gastric banding, sleeve gastrectomy, roux-en-y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch and revisional bariatric procedures (RBP) is assessed. A search on PubMed was performed for the most relevant articles in robotic bariatric surgery. A total of 23 articles was selected and reviewed in this article. The review showed that the use of robotics led to similar or lower complication rate in bariatric surgery when compared with laparoscopy. Two studies found a significantly lower leak rate for robotic gastric bypass when compared to laparoscopic method. The learning curve for RYGB seems to be shorter for robotic technique. Three studies revealed a significantly shorter operative time, while four studies found a longer operative time for robotic technique of gastric bypass. As for the outcomes of RBP, one study found a lower complication rate in robotic arm versus laparoscopic and open arms. Most authors stated that the use of robotics provides superior visualisation, more degrees of freedom and better ergonomics. The application of robotics in bariatric surgery seems to be a safe and feasible option. Use of robotics may provide specific advantages in some situations, and overcome limitations of laparoscopic surgery. Large and well-designed randomised clinical trials with long follow-up are needed to further define the role of digital platforms in bariatric surgery.

Robotic Assisted Bariatric Surgery

Intuitive Surgical, Inc., United States of America obtained Food and Drug Administration approval in 2000 and introduced the da VinciTM robot system in the United States providing an alternative platform for performing minimally invasive surgery. The system offers enhanced three-dimensional vision and wrist-like articulating instrumentation providing ergonomic and technical advantages to the surgeon. Soon after its introduction, we used the da VinciTM system, for complex abdominal operations including bariatric procedures. Its use has now been described for adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass and biliopancreatic diversion with or without duodenal switch.

Has mini gastric bypass come of age

Q4 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 Bruzzi et al. are to be congratulated for their contribution to the literature by describing 5-year outcomes of laparoscopic mini gastric bypass (LMGB) with 72% follow up. This contribution is important because LMGB is growing in numbers in countries outside the United States. The authors show that their LMGB patients had good weight loss and improved quality of life at 5 years. The mean percent excess body mass index loss was 71.5% with no mortality. Notably, 82% of patients had a complete remission of type 2 diabetes. The Gastrointestinal Quality of Life Index (GIQLI) score was significantly higher in patients who were 5 years post-LMGB compared with the preoperative control-group (110.3 17.4 versus 92.5 15.9) with an increase in physical, psychological, and social functions. These are excellent results. However, 9.6% of their patients required a surgical procedure for an early or late surgical complication. The incidence of weight loss failure was 4%, and the incidence of revision was 3.2% for excessive weight regain. This incidence of reoperation is higher than after a Roux-en-Y gastric bypass (RYGB), as pointed out by the authors themselves in their discussion [1,2]. The authors had vast experience in bariatric surgery including RYGB before performing LMBG and note that later in their LMBG experience, the reoperation rate declined, suggesting that there may be nuances that need to be learned to successfully perform and manage these patients. Although, the authors showed improved quality of life in LMGB patients, this study compares the preoperative and postoperative GIQLI scores in different sets of patients, and hence these conclusions need to be interpreted cautiously. Another statement that bears caution is that in the current experience, no cases of internal herniation were found with LMGB, and is a significant difference from RYGB. However, it should be noted that that the original description of internal hernia by Dr. Petersen was in patients who underwent a loop gastrojejunostomy (GJ) and which eventually resulted in mortality [3]. Thus, one should be cautious to look for internal herniation in all anastomotic bariatric procedures and mesenteric closure is recommended. LMGB was initially described in United States in late 90s and promising results of 41,000 patients were published in