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Spurzem GJ, Broderick RC, Kunkel EK, Hollandsworth HM, Sandler BJ, Jacobsen GR, Horgan S. Robotic sleeve gastrectomy has higher complication rates compared to laparoscopic: 8-year analysis of robotic versus laparoscopic primary bariatric surgery. Surg Obes Relat Dis 2025; 21:372-381. [PMID: 39732583 DOI: 10.1016/j.soard.2024.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 11/13/2024] [Accepted: 11/23/2024] [Indexed: 12/30/2024]
Abstract
BACKGROUND Robotic-assisted bariatric surgery is growing rapidly. The optimal approach to minimize complications remains unclear. OBJECTIVE Assess robot utilization and compare 30-day outcomes for laparoscopic and robotic primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. SETTING United States. METHODS A retrospective analysis of the MBSAQIP database identified primary SG and RYGB cases from 2015 to 2022. Revisions/conversions, cases converted to another approach, and combined cases other than esophagogastroduodenoscopy were excluded. Outcomes were compared with logistic regression following 1:1 propensity-score matching to adjust for differences in patient demographics/comorbidities and operative variables. RESULTS A total of 823,902 cases (591,118 SG; 232,784 RYGB) were included. From 2015 to 2022, the percentage of SG and RYGB performed robotically increased from 6.7% and 6.9% to 29.5% and 31.8%, respectively. Compared to laparoscopic, robotic SG had significantly higher overall morbidity (odds ratio 1.14 [1.07-1.21], P < .001), leak (1.24 [1.05-1.46], P = .03), and bleeding rates (1.34 [1.13-1.58], P < .001). Robotic RYGB had significantly lower overall morbidity (.75 [.70-.81], P < .001) and bleeding (.80 [.68-.94], P < .01) with similar leak rates (.87 [.71-1.07], P = .18). Combined robotic SG and RYGB outcomes were similar to laparoscopic for 2020-2022 cases, except for higher rates of organ/space infection, readmission, and septic shock in the robotic group. CONCLUSION Robotic SG has higher complication rates compared to laparoscopic, while robotic RYGB is protective against bleeding complications. Short-term outcomes for robotic surgery have become more similar to laparoscopic, but remain inferior. Further studies are warranted to elucidate the factors driving these findings.
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Affiliation(s)
- Graham J Spurzem
- Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego, San Diego, California.
| | - Ryan C Broderick
- Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Emily K Kunkel
- Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Hannah M Hollandsworth
- Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Bryan J Sandler
- Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Garth R Jacobsen
- Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Santiago Horgan
- Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego, San Diego, California
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Alomari M, Eroraha A, Spaulding A, Edwards MA. Gastric bypass performed with different surgical platforms during different periods. J Robot Surg 2025; 19:75. [PMID: 39976871 DOI: 10.1007/s11701-025-02232-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Accepted: 02/02/2025] [Indexed: 02/22/2025]
Abstract
Robotic gastric bypass (RGB) continues to increase. However, conflicting data remain on its impact on patient-reported outcomes. We utilized the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) databases. Gastric bypass cases performed with laparoscopy (LGB) or robotic assistance (RGB) between 2015 and 2021 were analyzed. A 1:1 matched analysis compared outcomes between LGB and RGB performed at different time intervals (2015-2018 vs. 2091-2021). 286,531 RYGB cases (87% LGB, 13% RGB) were analyzed, yielding 25,594 matched LGB and RGB cases. Mortality was low (0.1%) and comparable between cohorts. Surgical site infection (SSI) (0.9% vs. 1.3%, p < 0.001) and bleeding (0.3% vs. 0.4%, p = 0.04) were lower with RGB; however, readmission (5.8% vs. 4.9%, p < 0.001), reoperation (2.2% vs. 1.85%, p = 0.005), and morbidity (7.6% vs. 6.8%, p < 0.001) were higher. Operative length (OL) was longer for RGB (p < 0.001). In the early cohort, SSI and bleeding (p = 0.002 and p = 0.039) were lower for RGB; however, operative duration and LOS (p < 0.001) were more extended. In the later cohort, SSI (p = 0.006) and bleeding (p = 0.046) remained lower with RGB, while morbidity was higher (p = 0.005). Mean OL narrowed but remained longer for RGB (p < 0.001), while LOS was comparable. Both RGB and LGB demonstrate safety profiles with low mortality and morbidity. With increased robotic utilization, RGB was associated with a persistently reduced incidence of SSI and bleeding but longer OL.
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Affiliation(s)
- Mohammad Alomari
- Department of Surgery, Division of Advanced GI and Bariatric Surgery, Mayo Clinic Alix School of Medicine, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Ajiri Eroraha
- Ross University School of Medicine, Saint Michael, West Indies, Barbados
| | - Aaron Spaulding
- Robert D. and Patricia E. Kern Center, Mayo Clinic, Division of Health Care Delivery Research, Jacksonville, FL, USA
| | - Michael A Edwards
- Department of Surgery, Division of Advanced GI and Bariatric Surgery, Mayo Clinic Alix School of Medicine, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
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Aeschbacher P, Garoufalia Z, Rogers P, Dourado J, Liang H, Pena A, Szomstein S, Lo Menzo E, Rosenthal RJ. Laparoscopic versus robotic-assisted primary bariatric-metabolic surgery. Are we still expecting to overcome the learning curve? A propensity score-matched analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Surg Obes Relat Dis 2024; 20:831-839. [PMID: 39084914 DOI: 10.1016/j.soard.2024.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/07/2024] [Accepted: 03/16/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Robotic surgery is becoming increasingly popular in bariatric-metabolic surgery. However, its superiority regarding postoperative outcomes compared with conventional laparoscopy has not been clearly proven. With growing adoption of robotic surgery and improved technologies, benefits should become more evident. OBJECTIVES Evaluate readmission and reoperation rates after bariatric-metabolic surgery performed by conventional laparoscopy versus robotic-assisted from 2015 to 2021. SETTING Academic institution. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) was reviewed for primary bariatric operations performed with conventional laparoscopy versus robotic-assisted. Postoperative outcomes were compared in a propensity score-matched sample. RESULTS Of 1,059,348 cases meeting inclusion criteria, 921,322 (87%) were conventional laparoscopic bariatric-metabolic surgeries, which were matched 1:1 with robotic-assisted cases (138,026). Reoperation (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.00-1.15, P = .0463), postoperative morbidity (OR 1.07; 95% CI 1.01-1.12, P = .0193), readmission (OR 1.14; 95% CI 1.09-1.18, P < .0001), and emergency department visits (OR 1.06; 95% CI 1.03-1.09, P = .0003) at 30 days postoperatively were significantly greater for robotic-assisted cases. Robotic-assisted cases had a similar mortality rate at 30 days postoperatively and length of stay >3 days when compared with conventional laparoscopic cases. Similar results were observed in cases from 2020 to 2021, except for reoperation and emergency department visits, which showed no difference between groups and length of stay >3 days, which was greater in robotic-assisted cases. CONCLUSIONS Our results show a greater readmission and reoperation rate and greater morbidity at 30 days postoperatively in robotic-assisted bariatric-metabolic surgery compared with conventional laparoscopy. Analyzing only cases performed between 2020 and 2021, robotic surgery also does not show superiority over conventional laparoscopy.
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Affiliation(s)
- Pauline Aeschbacher
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Diseases Centre, Cleveland Clinic Florida, Weston, Florida
| | - Peter Rogers
- Ellen Leifer Shulman and Steven Shulman Digestive Diseases Centre, Cleveland Clinic Florida, Weston, Florida
| | - Justin Dourado
- Ellen Leifer Shulman and Steven Shulman Digestive Diseases Centre, Cleveland Clinic Florida, Weston, Florida
| | - Hong Liang
- Department of Clinical Research, Cleveland Clinic Florida, Weston, Florida
| | - Ana Pena
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
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Pennestrì F, Marincola G, Procopio PF, Gallucci P, Salvi G, Ciccoritti L, Greco F, Raffaelli M. Comparison between DaVinci ® and Hugo ™-RAS Roux-en-Y Gastric Bypass in bariatric surgery. J Robot Surg 2024; 18:303. [PMID: 39105863 PMCID: PMC11303586 DOI: 10.1007/s11701-024-02063-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 07/23/2024] [Indexed: 08/07/2024]
Abstract
The application of a robotic platform in the bariatric surgical field is intended to enhance the already established advantages of minimally invasive surgery in terms of both technical and clinical outcomes. These advantages are especially relevant for technically challenging multiquadrant operations such as Roux-en-Y Gastric Bypass (RYGB). Consequently, robotic-assisted surgery has emerged as a possible application for bariatric surgeries. The study attempts to assess feasibility and safety of the Hugo™-Robotic-Assisted Surgery System (Hugo™-RAS) platform compared to the DaVinci® Surgical System (DaVinci®-SS) with a focus on complication rates and operative times. We retrospectively reviewed bariatric procedures performed from January 2013 until December 2023. We included all robotic RYGBs performed using Hugo™-RAS and DaVinci®-SS platforms. The study utilized Propensity Score Matching (PSM) analysis to address bias in selection, matching patients based on age, gender, body mass index, comorbidities and past abdominal operations. One hundred thirty-five patients were identified: 90 DaVinci®-SS and 45 Hugo™-RAS procedures. After PSM, each group consisted of 45 patients. There was no discernible disparity observed in relation to early (≤ 30 days) postoperative complications rate (p = 1), mean operative time (for docking time, console time and total operative time: p = 0.176, p = 0.678, p = 0.229, respectively) and postoperative hospital stay (p = 0.052) between DaVinci®-RSS and Hugo™-RAS procedures. Our results suggest that application of both Hugo™-RAS and DaVinci®-SS robotic platforms to RYGB is related to comparable safety profiles. Although DaVinci®-SS remains the most widely adopted platform in clinical practice, this study underscores the potential role of the Hugo™-RAS to provide effective solutions in robotic bariatric procedures.
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Affiliation(s)
- Francesco Pennestrì
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca di Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Marincola
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Priscilla Francesca Procopio
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca di Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pierpaolo Gallucci
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Salvi
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Ciccoritti
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Greco
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Raffaelli
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Centro di Ricerca di Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy.
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Du X, Shen L, Xu S, Xu W, Yang J, Liu Y, Li K, Fan R, Yan L. Primary Robotic Versus Conventional Laparoscopic Roux-en-Y Gastric Bypass in Morbidly Obese Patients: A Systematic Review and Meta-Analysis. Surg Laparosc Endosc Percutan Tech 2024; 34:383-393. [PMID: 38828970 DOI: 10.1097/sle.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/29/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Robotic Roux-en-Y gastric bypass (RRYGB) and conventional laparoscopic Roux-en-Y gastric bypass (LRYGB) are commonly performed as primary bariatric procedures. The aim of this article was to assess the role of RRYGB in patients undergoing primary bariatric procedures. METHODS All of the qualified studies were selected from the PubMed, Embase, and Web of Science databases, etc. We mainly compared the outcomes and safety between RRYGB and LRYGB. The outcomes evaluation included surgical effect and surgical safety. RESULT In total, 35 studies containing 426,463 patients were selected. The mortalities of patients adopting these 2 bariatric procedures were similar (RRYGB: 59/28,023, 0.21%; LRYGB: 612/397,945, 0.15%). We found no significant difference between RRYGB and LRYGB in the incidence of postoperative complications (30-day: OR=1.06, P =0.18; 1-y: OR=1.06, P =0.92). The incidence of 30-day readmission after the operation was higher in RRYGB patients (OR=1.24, P =0.003). However, we found that the RRYGB group had a lower incidence of anastomotic stricture 1 year after the operation when compared with LRYGB (OR=0.35, P =0.0004). The 1-year %EBMIL of these 2 groups was similar (78.53% vs. 76.02%). There was no significant difference in length of hospital stay (LOS) (WMD=-0.03d, P =0.59), conversion rate (OR=0.84, P =0.75), or anastomotic leak (OR=1.00, P =0.99) between these 2 groups. The mean hospital charges were higher in the RRYGB group ($11234.75 vs. $9468.58). CONCLUSION This systematic review and meta-analysis showed no significant advantage of RRYGB in surgical effect or reduction of intraoperative complications. RRYGB may reduce the incidence of some postoperative long-term complications. The mean hospital charges of RRYGB were higher.
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Affiliation(s)
- Xiaoyu Du
- Department of General Surgery, the 940th Hospital of Joint Logistics Support Force of People's Liberation Army
- Northwest Minzu University
| | - Liwen Shen
- Department of Medical Information Data, the 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou, Gansu, China
| | - Shumei Xu
- Department of General Surgery, the 940th Hospital of Joint Logistics Support Force of People's Liberation Army
| | - Wei Xu
- Department of General Surgery, the 940th Hospital of Joint Logistics Support Force of People's Liberation Army
| | - Jiaxing Yang
- Department of General Surgery, the 940th Hospital of Joint Logistics Support Force of People's Liberation Army
| | - Yichen Liu
- Department of General Surgery, the 940th Hospital of Joint Logistics Support Force of People's Liberation Army
| | - Kun Li
- Department of General Surgery, the 940th Hospital of Joint Logistics Support Force of People's Liberation Army
| | - Ruifang Fan
- Department of General Surgery, the 940th Hospital of Joint Logistics Support Force of People's Liberation Army
| | - Long Yan
- Department of General Surgery, the 940th Hospital of Joint Logistics Support Force of People's Liberation Army
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Savulescu-Fiedler I, Mihalcea R, Dragosloveanu S, Scheau C, Baz RO, Caruntu A, Scheau AE, Caruntu C, Benea SN. The Interplay between Obesity and Inflammation. Life (Basel) 2024; 14:856. [PMID: 39063610 PMCID: PMC11277997 DOI: 10.3390/life14070856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Obesity is an important condition affecting the quality of life of numerous patients and increasing their associated risk for multiple diseases, including tumors and immune-mediated disorders. Inflammation appears to play a major role in the development of obesity and represents a central point for the activity of cellular and humoral components in the adipose tissue. Macrophages play a key role as the main cellular component of the adipose tissue regulating the chronic inflammation and modulating the secretion and differentiation of various pro- and anti-inflammatory cytokines. Inflammation also involves a series of signaling pathways that might represent the focus for new therapies and interventions. Weight loss is essential in decreasing cardiometabolic risks and the degree of associated inflammation; however, the latter can persist for long after the excess weight is lost, and can involve changes in macrophage phenotypes that can ensure the metabolic adjustment. A clear understanding of the pathophysiological processes in the adipose tissue and the interplay between obesity and chronic inflammation can lead to a better understanding of the development of comorbidities and may ensure future targets for the treatment of obesity.
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Affiliation(s)
- Ilinca Savulescu-Fiedler
- Department of Internal Medicine, The “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Internal Medicine and Cardiology, Coltea Clinical Hospital, 030167 Bucharest, Romania
| | - Razvan Mihalcea
- Department of Internal Medicine and Cardiology, Coltea Clinical Hospital, 030167 Bucharest, Romania
| | - Serban Dragosloveanu
- Department of Orthopaedics, “Foisor” Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania
- Department of Orthopaedics and Traumatology, The “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cristian Scheau
- Department of Physiology, The “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania (C.C.)
- Department of Radiology and Medical Imaging, “Foisor” Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 030167 Bucharest, Romania
| | - Radu Octavian Baz
- Clinical Laboratory of Radiology and Medical Imaging, “Sf. Apostol Andrei” County Emergency Hospital, 900591 Constanta, Romania
- Department of Radiology and Medical Imaging, Faculty of Medicine, “Ovidius” University, 900527 Constanta, Romania
| | - Ana Caruntu
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania
| | - Andreea-Elena Scheau
- Department of Radiology and Medical Imaging, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Constantin Caruntu
- Department of Physiology, The “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania (C.C.)
- Department of Dermatology, “Prof. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
| | - Serban Nicolae Benea
- Department of Infectious Diseases, The “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- “Prof. Dr. Matei Balș” National Institute for Infectious Diseases, 021105 Bucharest, Romania
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Clanahan JM, Awad MM, Dimou FM. Use of targeted educational resources to improve robotic bariatric surgery training. Surg Endosc 2024; 38:894-901. [PMID: 37823946 DOI: 10.1007/s00464-023-10436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Evidence for how to best train surgical residents for robotic bariatric procedures is lacking. We developed targeted educational resources to promote progression on the robotic bariatric learning curve. This study aimed to characterize the effect of resources on resident participation in robotic bariatric procedures. METHODS Performance metrics from the da Vinci Surgical System were retrospectively reviewed for sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) cases involving general surgery trainees with a single robotic bariatric surgeon. Pictorial case guides and narrated operative videos were developed for these procedures and disseminated to trainees. Percent active control time (%ACT)-amount of trainee console time spent in active instrument manipulations over total active time from both consoles-was the primary outcome measure following dissemination. One-way ANOVA, Student's t-tests, and Pearson correlations were applied. RESULTS From September 2020 to July 2021, 50 cases (54% SG, 46% RYGB) involving 14 unique trainees (PGY1-PGY5) were included. From November 2021 to May 2022 following dissemination, 29 cases (34% SG, 66% RYGB) involving 8 unique trainees were included. Mean %ACT significantly increased across most trainee groups following resource distribution: 21% versus 38% for PGY3s (p = 0.087), 32% versus 45% for PGY4s (p = 0.0009), and 38% versus 57% for PGY5s (p = 0.0015) and remained significant when stratified by case type. Progressive trainee %ACT was not associated with total active time for SG cases before or after intervention (pre r = - 0.0019, p = 0.9; post r = - 0.039, p = 0.9). It was moderately positively associated with total active time for RYGB cases before dissemination (r = 0.46, p = 0.027) but lost this association following intervention (r = 0.16, p = 0.5). CONCLUSION Use of targeted educational resources promoted increases in trainee participation in robotic bariatric procedures with more time spent actively operating at the console. As educators continue to develop robotic training curricula, efforts should include high-quality resource development for other sub-specialty procedures. Future work will examine the impact of increased trainee participation on clinical and patient outcomes.
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Affiliation(s)
- Julie M Clanahan
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Surgery, Washington University in St. Louis, 660 South Euclid Avenue, Mailstop 8109-22-9905, St. Louis, MO, 63110-1093, USA.
| | - Michael M Awad
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca M Dimou
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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8
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Behera K, McKenna M, Smith L, McKnight G, Horwood J, Davies MM, Torkington J, Ansell J. Transferring laparoscopic skills to robotic-assisted surgery: a systematic review. J Robot Surg 2024; 18:11. [PMID: 38214801 DOI: 10.1007/s11701-023-01757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/15/2023] [Indexed: 01/13/2024]
Abstract
Robotic-Assisted Surgery (RAS) is experiencing rapid expansion, prompting the integration of robotic technical skills training into surgical education programs. As access to robotic training platforms remains limited, it is important to investigate the transferability of laparoscopic skills to RAS. This could potentially support the inclusion of early years laparoscopic training to mitigate the learning curve associated with robotic surgery. This study aims to assess the transferability of laparoscopic skills to robotic surgery. A systematic search was conducted using the PRISMA checklist to identify relevant articles. PubMed, MEDLINE, Embase, and Cochrane databases were searched, and inclusion and exclusion criteria were applied to collate eligible articles. Included were original articles comparing the performance of comparable tasks on both laparoscopic and robotic platforms written in English. Non-peer reviewed papers, conference abstracts, reviews, and case series were excluded. Seventeen articles met the inclusion criteria. Among these, 10 studies (59%) demonstrated skill transferability from laparoscopic surgery (LS) to robotic surgery (RS); while one study (5.8%) showed no significant transferability. Four studies highlighted the positive impact of prior laparoscopic training on robotic skill, whereas six papers suggested no significant difference between laparoscopic novices and experienced laparoscopists when utilizing a robotic simulator. Five studies evaluated advanced surgical skills such as intracorporeal knot tying and suturing, revealing superior robotic performance among experienced laparoscopists compared to novice learners. Laparoscopic skills appear to be transferrable to robotic surgery, particularly in complex surgical techniques. Robotic simulators demonstrate a significant reduction in the learning curve for surgical novices, albeit to a lesser extent for experienced laparoscopists.
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Affiliation(s)
- Karishma Behera
- NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh, EH1 3EG, UK
| | - Matthew McKenna
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, Wales, UK
| | - Laurie Smith
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, Wales, UK
| | - Gerard McKnight
- Health Education and Improvement Wales (HEIW), Cardiff, Wales, UK
| | - James Horwood
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, Wales, UK
| | - Michael M Davies
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, Wales, UK
| | - Jared Torkington
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, Wales, UK
| | - James Ansell
- University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, Wales, UK.
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9
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Leang YJ, Mayavel N, Yang WTW, Kong JCH, Hensman C, Burton PR, Brown WA. Robotic versus laparoscopic gastric bypass in bariatric surgery: a systematic review and meta-analysis on perioperative outcomes. Surg Obes Relat Dis 2024; 20:62-71. [PMID: 37730445 DOI: 10.1016/j.soard.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/22/2023] [Accepted: 08/05/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Robotic-assisted surgery has emerged as a compelling approach to bariatric surgery. However, current literature has not consistently demonstrated superior outcomes to laparoscopic bariatric surgery to justify its higher cost. With its mechanical advantages, the potential gains from the robotic surgical platform are likely to be apparent in more complex cases such as gastric bypass, especially revisional cases. OBJECTIVE This systematic review and meta-analysis aimed to summarize the literature and evaluate the peri-operative outcomes of patients with obesity undergoing robotic gastric bypass versus laparoscopic gastric bypass surgery. SETTING Systematic review. METHODS A literature search of Embase, Medline, Pubmed, Cochrane library, and Google Scholar was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing outcomes of robotic and laparoscopic gastric bypass for obesity were included. RESULTS Twenty-eight eligible studies comprised a total of 82,155 patients; 9051 robotic bypass surgery (RBS) versus 73,104 laparoscopic bypass surgery (LBS) were included. All included studies compared Roux-en-Y gastric bypass. RBS was noted to have higher reoperation rate within 30 days (4.4% versus 3.4%; odds ratio 1.31 [95% CI, 1.04-1.66]; P = .027; I2 = 43.5%) than LBS. All other endpoints measured (complication rate, anastomotic leak, anastomotic stricture, surgical site infections, hospital readmission, length of stay, operative time, conversion rate and mortality) did not show any difference between RBS and LBS. CONCLUSION This systematic review and meta-analysis showed that there was no significant difference in key outcome measures in robotic versus laparoscopic gastric bypass. RBS was associated with a slightly higher reoperation rate and there was no reduction in overall complication rate with the use of robotic platform.
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Affiliation(s)
- Yit J Leang
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia.
| | - Naveen Mayavel
- Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Wilson T W Yang
- Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Joseph C H Kong
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Chrys Hensman
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Paul R Burton
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Wendy A Brown
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
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10
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Barros FD, Fonseca ABM, Kiss ASB, Braga CF, DA-Silva FR, Regonati YH. ROBOTIC VERSUS LAPAROSCOPIC ROUX-EN-Y-GASTRIC BYPASS: A RETROSPECTIVE STUDY IN A SINGLE CENTER. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1756. [PMID: 37729282 PMCID: PMC10510099 DOI: 10.1590/0102-672020230038e1756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/07/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Bariatric surgery is the best treatment option for patients with obesity. As a result of the advancement of technology, the robotic gastric bypass presents promising results, despite its still high costs. AIMS The aim of this study was to compare patients submitted to a robotic versus a laparoscopic gastric bypass at a single center by a single surgeon. METHODS This retrospective study collected data from the medical records of 221 patients (121 laparoscopic procedures versus 100 with daVinci platform). The variables analyzed were sex, age, body mass index, comorbidities, surgical time, length of stay, and complications. RESULTS The mean surgical time for patients in the robotic group was shorter (102.41±39.44 min versus 113.86±39.03 min, p=0.018). The length of hospital stay in robotic patients was shorter (34.12±20.59 h versus 34.93±11.74 h, p=0.007). There were no serious complications. CONCLUSIONS The group submitted to the robotic method had a shorter surgical time and a shorter hospital stay. No difference was found regarding strictures, bleeding, or leakage.
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Affiliation(s)
- Fernando de Barros
- Universidade Federal Fluminense, Department of General and Specialized Surgery - Niterói (RJ), Brazil
- DASA, Robotic Surgery - Rio de Janeiro (RJ), Brazil
| | | | | | - Camilla Ferreira Braga
- Universidade Federal Fluminense, Department of General and Specialized Surgery - Niterói (RJ), Brazil
| | | | - Yumi Honda Regonati
- Universidade Federal Fluminense, Department of General and Specialized Surgery - Niterói (RJ), Brazil
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11
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Salman MA, Salman A, Elewa A, Tourky M, Shaaban HED, Elshaer AM, Elhaj MGF, Gebril M, Elsherbiney M, Khalid S, Assal MM, Alasmar M. Cost-Effectiveness of Totally Robotic and Conventional Laparoscopic Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis. Bariatr Surg Pract Patient Care 2023; 18:144-153. [DOI: 10.1089/bari.2022.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Mohamed AbdAlla Salman
- General Surgery Department, KasrAlAiny School of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Salman
- Internal Medicine Department, KasrAlAiny School of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Elewa
- General Surgery Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Mohamed Tourky
- General Surgery Department, Great Western Hospital, NHS Foundation Trust, Swindon, United Kingdom
| | - Hossam El-Din Shaaban
- National Hepatology and Tropical Medicine Research Institute, Gastroenterology and Hepatology Department, Cairo, Egypt
| | - Ahmed Mohammed Elshaer
- General Surgery Department, KasrAlAiny School of Medicine, Cairo University, Cairo, Egypt
| | | | - Mahmoud Gebril
- General Surgery Department, Glangwill General Hospital, Carmarthen, Wales
| | - Mohammed Elsherbiney
- General Surgery Department, United Lincolnshire NHS Trust, Lincoln, United Kingdom
| | - Sadaf Khalid
- General Surgery Department, Royal Free London Hospital, NHS, London, United Kingdom
| | - Mohamed Moustafa Assal
- General Surgery Department, University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | - Mohamed Alasmar
- Division of Cancer Sciences, Salford Royal Hospital, University of Manchester, Manchester, United Kingdom
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12
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Kawka M, Fong Y, Gall TMH. Laparoscopic versus robotic abdominal and pelvic surgery: a systematic review of randomised controlled trials. Surg Endosc 2023; 37:6672-6681. [PMID: 37442833 PMCID: PMC10462573 DOI: 10.1007/s00464-023-10275-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND The current evidence is inconclusive on whether robotic or laparoscopic surgery is the optimal platform for minimally invasive surgery. Existing comparisons techniques focus on short-term outcomes only, while potentially being confounded by a lack of standardisation in robotic procedures. There is a pertinent need for an up-to-date comparison between minimally invasive surgical techniques. We aimed to systematically review randomised controlled trials comparing robotic and laparoscopic techniques in major surgery. METHODS Embase, Medline and Cochrane Library were searched from their inception to 13th September 2022. Included studies were randomised controlled trials comparing robotic and laparoscopic techniques in abdominal and pelvic surgery. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Short-term, health-related quality of life, and long-term, outcomes were analysed. RESULTS Forty-five studies, across thirteen procedures, involving 7364 patients were included. All of the studies reported non-significant differences in mortality between robotic and laparoscopic surgery. In majority of studies, there was no significant difference in complication rate (n = 31/35, 85.6%), length of postoperative stay (n = 27/32, 84.4%), and conversion rate (n = 15/18, 83.3%). Laparoscopic surgery was associated with shorter operative time (n = 16/31, 51.6%) and lower total cost (n = 11/13, 84.6%). Twenty three studies reported on quality of life outcomes; majority (n = 14/23, 60.9%) found no significant differences. CONCLUSION There were no significant differences between robotic surgery and laparoscopic surgery with regards to mortality and morbidity outcomes in the majority of studies. Robotic surgery was frequently associated with longer operative times and higher overall cost. Selected studies found potential benefits in post-operative recovery time, and patient-reported outcomes; however, these were not consistent across procedures and trials, with most studies being underpowered to detect differences in secondary outcomes. Future research should focus on assessing quality of life, and long-term outcomes to further elucidate where the robotic platform could lead to patient benefits, as the technology evolves.
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Affiliation(s)
- Michal Kawka
- Department of Medicine, Imperial College London, London, UK
| | - Yuman Fong
- Department of Surgery, City of Hope Medical Center, Duarte, CA, 91010, USA
| | - Tamara M H Gall
- Department of HPB Surgery, The Mater Misericordiae Hospital, Dublin, Ireland.
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13
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Tousignant MR, Liu X, Ershad Langroodi M, Jarc AM. Identification of Main Influencers of Surgical Efficiency and Variability Using Task-Level Objective Metrics: A Five-Year Robotic Sleeve Gastrectomy Case Series. Front Surg 2022; 9:756522. [PMID: 35586509 PMCID: PMC9108208 DOI: 10.3389/fsurg.2022.756522] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Surgical efficiency and variability are critical contributors to optimal outcomes, patient experience, care team experience, and total cost to treat per disease episode. Opportunities remain to develop scalable, objective methods to quantify surgical behaviors that maximize efficiency and reduce variability. Such objective measures can then be used to provide surgeons with timely and user-specific feedbacks to monitor performances and facilitate training and learning. In this study, we used objective task-level analysis to identify dominant contributors toward surgical efficiency and variability across the procedural steps of robotic-assisted sleeve gastrectomy (RSG) over a five-year period for a single surgeon. These results enable actionable insights that can both complement those from population level analyses and be tailored to an individual surgeon's practice and experience. Methods Intraoperative video recordings of 77 RSG procedures performed by a single surgeon from 2015 to 2019 were reviewed and segmented into surgical tasks. Surgeon-initiated events when controlling the robotic-assisted surgical system were used to compute objective metrics. A series of multi-staged regression analysis were used to determine: if any specific tasks or patient body mass index (BMI) statistically impacted procedure duration; which objective metrics impacted critical task efficiency; and which task(s) statistically contributed to procedure variability. Results Stomach dissection was found to be the most significant contributor to procedure duration (β = 0.344, p< 0.001; R = 0.81, p< 0.001) followed by surgical inactivity and stomach stapling. Patient BMI was not found to be statistically significantly correlated with procedure duration (R = -0.01, p = 0.90). Energy activation rate, a robotic system event-based metric, was identified as a dominant feature in predicting stomach dissection duration and differentiating earlier and later case groups. Reduction of procedure variability was observed between earlier (2015-2016) and later (2017-2019) groups (IQR = 14.20 min vs. 6.79 min). Stomach dissection was found to contribute most to procedure variability (β = 0.74, p < 0.001). Conclusions A surgical task-based objective analysis was used to identify major contributors to surgical efficiency and variability. We believe this data-driven method will enable clinical teams to quantify surgeon-specific performance and identify actionable opportunities focused on the dominant surgical tasks impacting overall procedure efficiency and consistency.
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Affiliation(s)
- Mark R. Tousignant
- Medical Safety and Innovation, Intuitive Surgical Inc., Sunnyvale, CA, United States
| | - Xi Liu
- Applied Research, Intuitive Surgical Inc., Peachtree Corners, GA, United States
| | | | - Anthony M. Jarc
- Applied Research, Intuitive Surgical Inc., Peachtree Corners, GA, United States
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14
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Landin MD, Gordee A, Lerebours RC, Kuchibhatla M, Eckhouse SR, Seymour KA. Trends in Risk Factors for Readmission after Bariatric Surgery 2015-2018. Surg Obes Relat Dis 2022; 18:581-593. [DOI: 10.1016/j.soard.2021.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/26/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022]
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15
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Oviedo RJ, Nayak T, Long Z, Yan M. Robotic Roux en Y gastric bypass can be safe and cost-effective in a rural setting: clinical outcomes from a community hospital bariatric program. J Robot Surg 2021; 15:929-936. [PMID: 33507471 DOI: 10.1007/s11701-021-01193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
Robotic Roux en Y gastric bypass (R-RYGB) is becoming more common due to the shifting trend toward robotic gastrointestinal surgery. The goal of this study is to determine if R-RYGB can be safely implemented at a robotic bariatric surgery program in a community hospital with similar results to laparoscopic RYGB (L-RYGB) in a cost-effective manner. A total of 50 R-RYGB procedures were performed with the Xi and the X da Vinci systems and compared with 50 L-RYGB cases by a single surgeon from October 2018 to January 2020 at an acute-care community hospital in a rural setting with a high-volume MBSAQIP-accredited program. A retrospective chart review was conducted with IRB approval and statistical analysis of 30-day morbidity, mortality, re-interventions, and resolution of co-morbidities, with financial analysis of cost reduction. Both groups were similar in age, gender, ASA class, co-morbidities, and body mass index (BMI). There was no mortality or anastomotic leak. The 30-day morbidity for R-RYGB was 10.0% with a re-operation rate of 4.0%. There were no conversions to open, and the mean hospital length of stay was 2.22 ± 1.19 days. There were no statistically significant differences between R-RYGB and L-RYGB with respect to any measured outcome, including intraoperative time (121.94 vs. 113.52, respectively; p = 0.1495). However, when incidences and percentages were used, R-RYGB had improved performance for most of the outcomes measuring safety. There was an average cost reduction of $816.90 per case (total saving of $40,845.00 for 50 cases) in the R-RYGB by transitioning from a hybrid approach to a totally robotic approach. R-RYGB appears to be as safe as L-RYGB and can be performed in a rural community hospital while maintaining a low complication rate, achieving a high co-morbidity resolution rate, and saving costs with a totally robotic approach.
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Affiliation(s)
- Rodolfo J Oviedo
- Department of Surgery, Houston Methodist, 6550 Fannin St, SM1661, Houston, TX, 77030, USA.
| | - Tapan Nayak
- Department of Statistics, George Washington University, 801 22nd St NW, Washington, DC, 20052, USA
| | - Zhuoxin Long
- Department of Statistics, George Washington University, 801 22nd St NW, Washington, DC, 20052, USA
| | - Mengying Yan
- Department of Statistics, George Washington University, 801 22nd St NW, Washington, DC, 20052, USA
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16
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Meneses E, Zagales I, Fanfan D, Zagales R, McKenney M, Elkbuli A. Surgical, metabolic, and prognostic outcomes for Roux-en-Y gastric bypass versus sleeve gastrectomy: a systematic review. Surg Obes Relat Dis 2021; 17:2097-2106. [PMID: 34642101 DOI: 10.1016/j.soard.2021.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/01/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this systematic review was to study 4 different aspects of Roux-en-Y gastric bypass (RYBG) and sleeve gastrectomy (SG). Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are two commonly performed bariatric procedures. This systematic review aims to compare RYGB with SG when it comes to weight changes, and cardiometabolic risk profile. Another aim was to evaluate laparoscopic and robotic techniques for both surgeries. PubMED, Cochrane Library, and JAMA Network were searched for articles evaluating RYGB and SG from 2005-2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Four different categories were analyzed comparing RYGB with SG as well as robotic versus laparoscopic approach. The Critical Appraisal Skills Program (CASP) checklist was used to assess the quality of evidence in the studies included in this systematic review. A total of 29 studies were included looking at different aspects of RYGB and SG. RYGB is superior to SG for weight loss, improved or complete remission of cholesterol and hypertensive medications. Consensus is lacking regarding decrease in BMI, total cholesterol, and triglycerides. There is lack of evidence regarding decrease of incidence of MI or stroke. For RYGB and SG, the majority of studies found that the robotic technique was more expensive and took longer. RYGB when compared with SG was associated with larger weight loss, decreased or cessation of cholesterol and hypertensive medications, and lower cholesterol. Decrease in BMI had varying results, with RYGB being superior in more studies, while there was no difference in other studies. There was a lack of evidence to support if RYGB or SG was superior to decreasing triglyceride levels. For both RYGB and SG, the robotic approach was costlier and took more operating time versus the laparoscopic approach.
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Affiliation(s)
- Evander Meneses
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Israel Zagales
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Dino Fanfan
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Ruth Zagales
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida; Department of Surgery, University of South Florida, Tampa, Florida
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida.
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17
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Vilallonga R, García Ruiz de Gordejuela A, Fort JM, Gonzalez O, Rodríguez-Luna MR, Roriz-Silva R, Caubet E, Ciudin A, Pera-Ferreruela M, Petrola C, Armengol M. Laparoscopic Versus Robot-Assisted Roux-en-Y Gastric Bypass: A Center of Excellence for the EAC-BC Experience. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34612707 DOI: 10.1089/lap.2021.0528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: After the first laparoscopic Roux-en-Y gastric bypass (RYGB) in 1994 by Wittgrove, the introduction of robot-assisted procedures was the next step in the surgical race to reduce invasiveness. This breakthrough allowed us to perform bariatric surgery with less surgical trauma in obese patients with metabolic disorders, producing an exponential increase in procedures performed. Methods: This is a retrospective cohort study of a prospective database for patients who underwent RYGB during a 7-year period through two different approaches, laparoscopic and robotic. The robotic cases were performed by two generations of the da Vinci platform (S and Xi), and three groups were identified and compared (L-RYGB, RYGB-S, and RYGB-Xi). Results: A total of 495 patients underwent RYGB, of which 224 by laparoscopy (45.2%) and 271 by robotic approach (54.7%): 134 RYGB-S and 137 RYGB-Xi. The majority of the patients (71.1%) were females, with a mean age of 46.2 years and a mean body mass index of 44 kg/m2. The mean intraoperative time and intraoperative complication rate were higher in the robotic groups, especially in the RYGB-S group. Postoperative complications were higher in the same group, with a rate of 11.9%, where the main leakage occurred on the upper part of the gastric pouch and not in the hand-sewed robotic anastomosis (7.5%). General mortality was 0.6%. We found no significant differences at 1-year percentage of total weight loss (%TWL); at 2 years, the RYGB-Xi group had the lowest %TWL (25.24 ± 14.54, P ≤ .001). Conclusions: The present study reflects our experience during the robotic bariatric introduction and performance since 2011. Features of the da Vinci S platform along our learning curve may explain a higher complication rate. The patients who have been operated by the RYGB-Xi system had lower complications than the laparoscopic group. The robotic approach did not differ with laparoscopy in terms of weight loss and chronic complications after 24 months of follow-up.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
- ELSAN Clinic, Surgery Department, Clinique Saint Michel, Av. D'orient, Toulon, France
| | - Amador García Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Rita Rodríguez-Luna
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Renato Roriz-Silva
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Medicine, Federal University of Rondonia, Rondonia, Brazil
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Ciudin
- Department of Endocrinolgy and Nutrition and Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Meritxell Pera-Ferreruela
- Department of General Surgery, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Petrola
- Department of General Surgery, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Armengol
- Department of General Surgery, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
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18
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Dhanani NH, Olavarria OA, Bernardi K, Lyons NB, Holihan JL, Loor M, Haynes AB, Liang MK. The Evidence Behind Robot-Assisted Abdominopelvic Surgery : A Systematic Review. Ann Intern Med 2021; 174:1110-1117. [PMID: 34181448 DOI: 10.7326/m20-7006] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Use of robot-assisted surgery has increased dramatically since its advent in the 1980s, and nearly all surgical subspecialties have adopted it. However, whether it has advantages compared with laparoscopy or open surgery is unknown. PURPOSE To assess the quality of evidence and outcomes of robot-assisted surgery compared with laparoscopy and open surgery in adults. DATA SOURCES PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials were searched from inception to April 2021. STUDY SELECTION Randomized controlled trials that compared robot-assisted abdominopelvic surgery with laparoscopy, open surgery, or both. DATA EXTRACTION Two reviewers independently extracted study data and risk of bias. DATA SYNTHESIS A total of 50 studies with 4898 patients were included. Of the 39 studies that reported incidence of Clavien-Dindo complications, 4 (10%) showed fewer complications with robot-assisted surgery. The majority of studies showed no difference in intraoperative complications, conversion rates, and long-term outcomes. Overall, robot-assisted surgery had longer operative duration than laparoscopy, but no obvious difference was seen versus open surgery. LIMITATIONS Heterogeneity was present among and within the included surgical subspecialties, which precluded meta-analysis. Several trials may not have been powered to assess relevant differences in outcomes. CONCLUSION There is currently no clear advantage with existing robotic platforms, which are costly and increase operative duration. With refinement, competition, and cost reduction, future versions have the potential to improve clinical outcomes without the existing disadvantages. PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42020182027).
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Affiliation(s)
- Naila H Dhanani
- McGovern Medical School at UTHealth, Houston, Texas (N.H.D., O.A.O., K.B., N.B.L., J.L.H.)
| | - Oscar A Olavarria
- McGovern Medical School at UTHealth, Houston, Texas (N.H.D., O.A.O., K.B., N.B.L., J.L.H.)
| | - Karla Bernardi
- McGovern Medical School at UTHealth, Houston, Texas (N.H.D., O.A.O., K.B., N.B.L., J.L.H.)
| | - Nicole B Lyons
- McGovern Medical School at UTHealth, Houston, Texas (N.H.D., O.A.O., K.B., N.B.L., J.L.H.)
| | - Julie L Holihan
- McGovern Medical School at UTHealth, Houston, Texas (N.H.D., O.A.O., K.B., N.B.L., J.L.H.)
| | - Michele Loor
- Baylor College of Medicine, Houston, Texas (M.L.)
| | - Alex B Haynes
- Dell Medical School at the University of Texas, Austin, Texas (A.B.H.)
| | - Mike K Liang
- University of Houston, HCA Kingwood, Kingwood, Texas (M.K.L.)
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19
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Zhang Z, Miao L, Ren Z, Li Y. Robotic bariatric surgery for the obesity: a systematic review and meta-analysis. Surg Endosc 2021; 35:2440-2456. [PMID: 33881624 DOI: 10.1007/s00464-020-08283-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/31/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this meta-analysis is to evaluate the safety and efficacy of bariatric surgery (BS) in patients with obesity by robotic bariatric surgery (RBS) compared with laparoscopic bariatric surgery (LBS). METHODS The study was performed through searching in Pubmed, Web of Science, Embase database and Cochrane Library until March 31, 2020 comparing RBS with LBS. Data were calculated on the following endpoints: operative time, length of hospital stay, reoperation within 30 days, overall complications, leak, stricture, pulmonary embolisms, estimated blood loss and mortality. Data as relative risks (OR), or weighted mean difference (WMD) were summarized with 95% confidence interval (CI). Risk of publication bias was assessed through standard methods. RESULTS Thirty eligible trials including 7,239 robotic and 203,181 laparoscopic surgery cases showed that RBS was referred to attain longer operative time [WMD = 27.61 min; 95%CI (16.27-38.96); P < 0.01] and lower mortality [OR 2.40; 95% CI (1.24-4.64); P = 0.009] than LBS. Length of hospital stay [WMD = - 0.02; 95% CI (- 0.19-0.15); P = 0.819], reoperation within 30 days [OR 1.36; 95% CI (0.65-2.82); P = 0.411], overall complications [OR 0.88; 95% CI (0.68-1.15); P = 0.362], leak [OR 1.04; 95% CI (0.43-2.51); P = 0.933], stricture [OR 1.05; 95% CI (0.52-2.12); P = 0.895], pulmonary embolisms [OR 1.97; 95% CI (0.93-4.17); P = 0.075], estimated blood loss[WMD = - 1.93; 95% CI (- 4.61-0.75); P = 0.158] were almost similar in both RBS group and LBS group. Three was no statistically significant difference between RRYGB and LRYGB in EWL%, no statistical significance between RSG and LSG after 1 year, 2 years and 3 years. CONCLUSION RBS presented lower mortality within 90 days and longer operative time in this meta-analysis with similar safety and efficacy for the obesity compared with LBS in other outcomes. Additionally, RBS might be beneficial in the future if it would be evaluated in comprehensive and long-term endpoints.
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Affiliation(s)
- Zhengchao Zhang
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, China
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou, 730000, China
| | - Lele Miao
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, China
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou, 730000, China
| | - Zhijian Ren
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, China
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou, 730000, China
| | - Yumin Li
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, China.
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou, 730000, China.
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The Impact of Robotics in Learning Roux-en-Y Gastric Bypass: a Retrospective Analysis of 214 Laparoscopic and Robotic Procedures : Robotic Vs. Laparoscopic RYGB. Obes Surg 2021; 30:2403-2410. [PMID: 32124220 PMCID: PMC7475058 DOI: 10.1007/s11695-020-04508-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Proximal Roux-en-Y gastric bypass is commonly used to manage obesity, performed using laparoscopic or robot-assisted minimally invasive surgery. As the prevalence of robotic bariatric surgery increases, further data is required to justify its use. METHODS This was a large, retrospective analysis of prospectively recorded data for Roux-en-Y gastric bypass (RYGB) procedures performed using laparoscopic (LRYGB) or robotic (RRYGB; da Vinci Xi system, Intuitive Surgical Sàrl) surgery between January 2016 and March 2019. The surgical techniques did not differ apart from different trocar placements. Data collected included patient characteristics before and after RYGB, operative outcomes and complications. RESULTS In total, 114 RRYGB and 108 LRYGB primary surgeries were performed. There were no significant differences between the groups, apart from a significantly shorter duration of surgery (116.9 vs. 128.9 min, respectively), lower C-reactive protein values at days 1 (31.1 vs. 44.1 mg/l) and 2 (50.3 vs. 77.8 mg/l) after the intervention, and overall complication rate (4.4 vs. 12.0%, Clavien-Dindo classification II-V) with RRYGB compared with LRYGB. There was a lower hemoglobin value in the postoperative course after RRYGB (12.1 vs. 12.6 g/dl, day 2). CONCLUSIONS In our experience, robotic RYGB has proven to be safe and efficient, with a shorter duration of surgery and lower rate of complications than laparoscopic RYGB. RRYGB is easier to learn and seems safer in less experienced centers. Increasing experience with the robotic system can reduce the duration of surgery over time. Further studies with higher evidence level are necessary to confirm our results.
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21
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Kersebaum JN, Möller T, von Schönfels W, Taivankhuu T, Becker T, Egberts JH, Beckmann JH. Robotic Roux-en-Y Gastric Bypass Procedure Guide. JSLS 2021; 24:JSLS.2020.00062. [PMID: 33293782 PMCID: PMC7678257 DOI: 10.4293/jsls.2020.00062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose This is a step-by-step procedural guide to help new and unexperienced surgeons with the implementation of a robotic program for the surgical treatment of morbid obesity. Methods Based on our vast robotic experience, we present our standardized technique and also, with a PubMed research, discuss the different surgical aspects. Results We present our trainings pathway towards the first robotic Roux-en-Y gastric bypass, a step-by-step procedural guide with helpful hints when it comes to troubleshooting and also discuss some surgical aspects. Conclusion The robotic Roux-en-Y gastric bypass is safe and feasible, and might offer some advantages in comparison to the laparoscopic approach.
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Affiliation(s)
- Jan-Niclas Kersebaum
- University Medical Center Schleswig-Holstein, Campus Kiel, Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Thorben Möller
- University Medical Center Schleswig-Holstein, Campus Kiel, Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Witigo von Schönfels
- University Medical Center Schleswig-Holstein, Campus Kiel, Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Terbish Taivankhuu
- University Medical Center Schleswig-Holstein, Campus Kiel, Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Thomas Becker
- University Medical Center Schleswig-Holstein, Campus Kiel, Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Jan-Hendrik Egberts
- University Medical Center Schleswig-Holstein, Campus Kiel, Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Jan Henrik Beckmann
- University Medical Center Schleswig-Holstein, Campus Kiel, Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Arnold-Heller-Str. 3, 24105 Kiel, Germany
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Intraoperative conversion and complications in robotic assisted primary and redo gastric bypass surgery. J Robot Surg 2021; 16:235-239. [PMID: 33797010 DOI: 10.1007/s11701-021-01212-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/03/2021] [Indexed: 10/21/2022]
Abstract
The rise of robotic assisted surgery in the treatment of morbidly obese patients has enlarged the armamentarium for surgeons involved in bariatric surgery. This in particular is of great advantage not only in primary cases, but also in patients undergoing revisional procedures following preceding upper GI surgery. In the following, our experience with intraoperative conversions and complications in revisional robotic surgery using the Da Vinci robotic system will be reported and compared to primary robotic bypass surgery and the literature. In a 36-month period, a total of 157 minimally invasive bariatric procedures (48 robotic assisted, 109 laparoscopic) were performed. Out of 43 patients receiving a gastric bypass 32 (74%) were performed robotically. Out of these 20 (62.5%) had previous operations (RRBP): one hiatal mesh repair, one open Mason operation, eight gastric band, nine gastric sleeve, one sleeve with fundoplication. The Da Vinci Xi was used for all surgeries. 3/20 (15%) RRBP were converted to open laparotomy because of a huge left liver lobe (1), extreme adhesions (1) and short mesentery (1) (p = 0.631 vs 1/12 RBP). One out of these had to be reoperated for an insufficiency of the gastroenterostomy. 3/17 (23%) patients (RRBP) without conversion had complications: hemorrhage (1), insufficiency of biliodigestive anastomosis (1), insufficiency of gastroenterostomy (1). There was no mortality and length of hospital stay was 3.5 days in uncomplicated cases and 12.3 days in complicated cases (p < 0.05). This preliminary experience suggests, that robotic revisional surgery can be performed safely even in complicated cases. Conversion to laparoscopic or open surgery may be required when adverse anatomical conditions are present. However, the incidence of complications was not increased when conversion was performed. In this series, the incidence of complications was not greater in case of revisional surgery.
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Bienvenot R, Sirveaux MA, Nguyen-Thi PL, Brunaud L, Quilliot D. Symptomatic Hypoglycemia After Gastric Bypass: Incidence and Predictive Factors in a Cohort of 1,138 Consecutive Patients. Obesity (Silver Spring) 2021; 29:681-688. [PMID: 33608995 DOI: 10.1002/oby.23118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE After Roux-en-Y gastric bypass (RYGB), postprandial hyperinsulinemic hypoglycemia (PPHH) is particularly critical because of the risk of trauma. The aim of this study was to assess the incidence and identify risk factors for symptomatic PPHH. METHODS Patients with RYGB were classified into moderate PPHH (MH) or severe hypoglycemia (SH), which is defined as patients with neuroglycopenic symptoms. Logistic multivariate linear regressions were performed to identify predictive factors for symptomatic PPHH and more specifically for SH with neuroglycopenic symptoms. Patients with diabetes and those with a follow-up shorter than 2 years were excluded. RESULTS Among the 1,138 patients, 44.2% had at least one episode of hypoglycemia with a mean delay of 25.5 (21.3) months, 32.6% had MH, and 11.6% had SH. The annual incidence rate of SH was 2.5% the first year, 3.7% the second year, and 1.5% the third year. Independent predictive factors for higher risk of SH were: younger age (odds ratio [OR] = 1.01; 95% CI: 1.05-16.69; P = 0.0007), lower BMI after RYGB (OR = 1.61; 95% CI: 1.17-2.22; P = 0.0035), and maximal weight loss (OR = 1.04; 95% CI = 1.39-1.23; P = 0.0106), whereas higher preoperative BMI was protective (OR = 0.78; 95% CI: 0.64-0.95; P = 0.0112). CONCLUSIONS This observational cohort study showed that the incidence of severe PPHH with neuroglycopenic symptoms after RYGB was higher than expected.
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Affiliation(s)
- Rébecca Bienvenot
- Department of Endocrinology, Diabetology and Nutrition, University of Lorraine, CHRU Nancy, Brabois Hospital, Nancy, France
| | - Marie-Aude Sirveaux
- Department of Visceral, Metabolic and Cancer Surgery (CVMC), Multidisciplinary Unit for Obesity Surgery (UMCO), University of Lorraine, CHRU Nancy, Brabois Hospital, Vandoeuvre-lès-Nancy, France
| | - Phi-Linh Nguyen-Thi
- Medical Evaluation Department, Department of Clinical Research Support PARC, University of Lorraine, CHU Nancy, Nancy, France
| | - Laurent Brunaud
- Department of Visceral, Metabolic and Cancer Surgery (CVMC), Multidisciplinary Unit for Obesity Surgery (UMCO), University of Lorraine, CHRU Nancy, Brabois Hospital, Vandoeuvre-lès-Nancy, France
- INSERM U1256, Nutrition, Genetics, Environmental Risks, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Didier Quilliot
- Department of Endocrinology, Diabetology and Nutrition, University of Lorraine, CHRU Nancy, Brabois Hospital, Nancy, France
- Department of Visceral, Metabolic and Cancer Surgery (CVMC), Multidisciplinary Unit for Obesity Surgery (UMCO), University of Lorraine, CHRU Nancy, Brabois Hospital, Vandoeuvre-lès-Nancy, France
- INSERM U1256, Nutrition, Genetics, Environmental Risks, Faculty of Medicine, University of Lorraine, Nancy, France
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Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews. Ann Surg 2021; 273:467-473. [PMID: 32398482 DOI: 10.1097/sla.0000000000003915] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Describe clinical outcomes (eg, postoperative complications, survival) after robotic surgery compared to open or laparoscopic surgery. BACKGROUND Robotic surgery utilization has increased over the years across a wide range of surgical procedures. However, evidence supporting improved clinical outcomes after robotic surgery is limited. METHODS We systematically searched MEDLINE, EMBASE, and the Cochrane Central Register of systematic reviews from inception to January 2019 for systematic reviews describing postoperative outcomes after robotic surgery. We qualitatively described patient outcomes of commonly performed robotic procedures: radical prostatectomy, hysterectomy, lobectomy, thymectomy, rectal resection, partial nephrectomy, distal gastrectomy, Roux-en-Y gastric bypass, hepatectomy, distal pancreatectomy, and cholecystectomy. RESULTS One hundred fifty-four systematic reviews included 336 studies and 18 randomized controlled trials reporting on patient outcomes after robotic compared to laparoscopic or open procedures. Data from the randomized controlled trials demonstrate that robotic-assisted radical prostatectomy offered fewer biochemical recurrence and improvement in quality of recovery and pain scores only up to 6 weeks postoperatively compared to open radical prostatectomy. When compared to laparoscopic prostatectomy, robotic surgery offered improved urinary and sexual functions. Robotic surgery for endometrial cancer had fewer conversion to open compared to laparoscopic. Otherwise, robotic surgery outcomes were similar to conventional surgical approaches for other procedures except for radical hysterectomy where minimally invasive approaches may result in patient harm compared to open approach. CONCLUSION Robotic surgery has been widely incorporated into practise despite limited supporting evidence. More rigorous research focused on patient-important benefits is needed before further expansion of robotic surgery.
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Abstract
Significant improvements have been made in bariatric surgery for the past two decades. Thus, early and late complication rates decreased significantly. Thanks to its promising results, robotic surgery is finding increasing use in the field of surgery and the bariatric surgery is one of these areas. Following the first robotic bariatric surgery in 1997, it continues to be performed at increasing rates thanks to the advantages it brings. Robotic surgery offers new opportunities to improve bariatric surgery, thanks to remote control mechanical arms. The three-dimensional (3D) view, together with the precision of movements and the freedom of arms offer new insights into the more difficult surgeries. Hospitals should prepare a good business plan to financially activate robotic surgery, thus, more robotic procedures can be achieved. Among the expressed concerns for the Da Vinci Systems are issues such as the costs, operational times, and lack of tactile feedback. Annual maintenance fees and instrument costs are undoubtedly higher than laparoscopic surgery methods. Robotic surgery is now integrated into obesity surgery, such as sleeve gastrectomy, Roux-en-Y gastric bypass, one anastomosis gastric bypass, biliopancreatic diversion and single anastomosis duodenal switch. It allows for more efficient and ideal anastomosis and exposure in challenging fields. Robotic bariatric surgery is a safe procedure with a short learning curve, outcomes comparable to laparoscopy and other benefits of robotic technology.
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Affiliation(s)
- Mahir Ozmen
- Department of Surgery, School of Medicine, Istinye University, Istanbul, Turkey - .,Liv Hospital, Ankara, Turkey -
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26
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Hagen ME, Douissard J. Economics of Robotic Bariatric Surgery in Europe. ROBOTIC SURGERY 2021:737-740. [DOI: 10.1007/978-3-030-53594-0_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Abstract
The global numbers of robotic gastrointestinal surgeries are increasing. However, the evidence base for robotic gastrointestinal surgery does not yet support its widespread adoption or justify its cost. The reasons for its continued popularity are complex, but a notable driver is the push for innovation - robotic surgery is seen as a compelling solution for delivering on the promise of minimally invasive precision surgery - and a changing commercial landscape delivers the promise of increased affordability. Novel systems will leverage the robot as a data-driven platform, integrating advances in imaging, artificial intelligence and machine learning for decision support. However, if this vision is to be realized, lessons must be heeded from current clinical trials and translational strategies, which have failed to demonstrate patient benefit. In this Perspective, we critically appraise current research to define the principles on which the next generation of gastrointestinal robotics trials should be based. We also discuss the emerging commercial landscape and define existing and new technologies.
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Beckmann JH, Mehdorn AS, Kersebaum JN, von Schönfels W, Taivankhuu T, Laudes M, Egberts JH, Becker T. Pros and Cons of Robotic Revisional Bariatric Surgery. Visc Med 2020; 36:238-245. [PMID: 32775356 DOI: 10.1159/000507742] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/03/2020] [Indexed: 01/06/2023] Open
Abstract
Introduction Revisional procedures in bariatric surgery are regarded as technically more demanding and riskier than primary interventions. While the use of the surgical robot has not yet proven to be advantageous in primary bariatric interventions, the question remains whether its use is justified for more complex revisional procedures. Objective To show that revisional bariatric surgery can be performed safely using the da Vinci® Xi surgical system. Methods We performed a retrospective analysis of prospectively recorded data for revisional bariatric procedures between January 2016 and November 2019. Results Of 78 revision operations, four (5.1%) were performed by open surgery, 30 (38.5%) by laparoscopic surgery, and 44 (56.4%) by robotic surgery. A comparative analysis of robotic (n = 41) versus laparoscopic (n = 18) revisional Roux-en-Y gastric bypasses (rRYGB) revealed significant differences favoring the robotic approach for operative time (130.7 vs. 167.6 min), C-reactive protein values at days 1 (27.9 vs. 49.1 mg/L) and 2 (48.2 vs. 83.6 mg/L) after surgery, and length of stay (4.9 vs. 6.2 days). Lower complication rates (Clavien-Dindo II-V) were found after rRRYGB (7.3 vs. 22.2%, not significant). Conclusions Revisional bariatric surgery using a robotic system is safe. The operative time performing rRRYGB is significantly shorter than rLRYGB in our experience. Otherwise, results were largely comparable. Due to different indications, different index operations and a wide range of revisional procedures, further studies are necessary to confirm these results.
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Affiliation(s)
- Jan Henrik Beckmann
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Anne-Sophie Mehdorn
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan-Niclas Kersebaum
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Witigo von Schönfels
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Terbish Taivankhuu
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Matthias Laudes
- I. Department of Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan-Hendrik Egberts
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thomas Becker
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Kostakis ID, Sran H, Uwechue R, Chandak P, Olsburgh J, Mamode N, Loukopoulos I, Kessaris N. Comparison Between Robotic and Laparoscopic or Open Anastomoses: A Systematic Review and Meta-Analysis. ROBOTIC SURGERY (AUCKLAND) 2019; 6:27-40. [PMID: 31921934 PMCID: PMC6934120 DOI: 10.2147/rsrr.s186768] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/10/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Robotic surgery has been increasingly used in fashioning various surgical anastomoses. Our aim was to collect and analyze outcomes related to anastomoses performed using a robotic approach and compare them with those done using laparoscopic or open approaches through meta-analysis. METHODS A systematic review was conducted for articles comparing robotic with laparoscopic and/or open operations (colectomy, low anterior resection, gastrectomy, Roux-en-Y gastric bypass (RYGB), pancreaticoduodenectomy, radical cystectomy, pyeloplasty, radical prostatectomy, renal transplant) published up to June 2019 searching Medline, Scopus, Google Scholar, Clinical Trials and the Cochrane Central Register of Controlled Trials. Studies containing information about outcomes related to hand-sewn anastomoses were included for meta-analysis. Studies with stapled anastomoses or without relevant information about the anastomotic technique were excluded. We also excluded studies in which the anastomoses were performed extracorporeally in laparoscopic or robotic operations. RESULTS We included 83 studies referring to the aforementioned operations (4 randomized controlled and 79 non-randomized, 10 prospective and 69 retrospective) apart from colectomy and low anterior resection. Anastomoses done using robotic instruments provided similar results to those done using laparoscopic or open approach in regards to anastomotic leak or stricture. However, there were lower rates of stenosis in robotic than in laparoscopic RYGB (p=0.01) and in robotic than in open radical prostatectomy (p<0.00001). Moreover, all anastomoses needed more time to be performed using the robotic rather than the open approach in renal transplant (p≤0.001). CONCLUSION Robotic anastomoses provide equal outcomes with laparoscopic and open ones in most operations, with a few notable exceptions.
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Affiliation(s)
- Ioannis D Kostakis
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Harkiran Sran
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Raphael Uwechue
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Pankaj Chandak
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Jonathon Olsburgh
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Nizam Mamode
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ioannis Loukopoulos
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Nicos Kessaris
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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The Impact of Corporate Payments on Robotic Surgery Research: A Systematic Review. Ann Surg 2019; 269:389-396. [PMID: 30067545 DOI: 10.1097/sla.0000000000003000] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To quantify the influence of financial conflict of interest (COI) payments on the reporting of clinical results for robotic surgery. DATA SOURCES AND STUDY SELECTION A systematic search (Ovid MEDLINE databases) was conducted (May 2017) to identify randomized controlled trials (RCTs) and observational studies comparing the efficacy of the da Vinci robot on clinical outcomes. Financial COI data for authors (per study) were determined using open payments database. MAIN OUTCOMES AND MEASURES Primary outcomes assessed were receipt of financial COI payments and overall conclusion reported between robotic versus comparative approach. Quality/risk of bias was assessed using Newcastle-Ottawa Scale (NOS)/Cochrane risk of bias tool. Disclosure discrepancies were also analyzed. DATA EXTRACTION AND SYNTHESIS Study characteristics, surgical subspecialty, methodological assessment, reporting of disclosure statements, and study findings dual abstracted. The association of the amount of financial support received as a predictor of reporting positive findings associated robotic surgery was assessed at various cut-offs of dollar amount received by receiver operating curve (ROC). RESULTS Thirty-three studies were included, 9 RCTs and 24 observational studies. There was a median, 111 patients (range 10 to 6420) across studies. A little more than half (17/33) had a conclusion statement reporting positive results in support of robotic surgery, with 48% (16/33) reporting results not in favor [equivocal: 12/33 (36%), negative: 4/33 (12%)]. Nearly all (91%) studies had authors who received financial COI payments, with a median of $3364.46 per study (range $9 to $1,775,378.03). ROC curve demonstrated that studies receiving greater than $9557.31 (cutpoint) were more likely to report positive robotic surgery results (sensitivity: 0.65, specificity: 0.81, area under the curve: 0.73). Studies with financial COI payment greater than this amount were more likely to report beneficial outcomes with robotic surgery [(78.57% vs 31.58%, P = 0.013) with an odds ratio of 2.07 (confidence interval: 0.47-3.67; P = 0.011)]. Overall, studies were high quality/low risk of bias [median NOS: 8 (range 5 to 9)]; Cochrane risk: "low risk" (9/9, 100%)]. CONCLUSION AND RELEVANCE Financial COI sponsorship appears to be associated with a higher likelihood of studies reporting a benefit of robotic surgery. Our findings suggest a dollar amount where financial payments influence reported clinical results, a concept that challenges the current guidelines, which do not account for the amount of COI funding received.
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Bustos R, Mangano A, Gheza F, Chen L, Aguiluz-Cornejo G, Gangemi A, Sanchez-Johnsen L, Hassan C, Masrur M. Robotic-Assisted Roux-en-Y Gastric Bypass: Learning Curve Assessment Using Cumulative Sum and Literature Review. Bariatr Surg Pract Patient Care 2019; 14:95-101. [PMID: 31572625 PMCID: PMC6763956 DOI: 10.1089/bari.2018.0042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose: Robotic-assisted Roux-en-Y gastric bypass (RARYGB) is a procedure that is used with increasing frequency in the United States. Among other bariatric procedures, RARYGB is a good model for the robotic platform because it allows hand-sewn suturing and energy devices application. The aim of this study was to conduct a literature review of robotic approach in RARYGB, its learning curve using the cumulative sum (CUSUM) method, and our experience as Center of Excellence recognized by the American Society for Metabolic and Bariatric Surgery (ASMBS). Methods: A total of 67 patients were included. Results revealed that the learning curve was achieved after case 11. Eighteen studies were included in the pooled analysis. Results: An increase in the operative time was noted at case 46, in which a second phase was identified. A significant difference between these two phases was found only related to previous bariatric surgery. The outcomes of this series were comparable with the ones available in the literature. Conclusions: The robotic platform is increasing its role in complex procedures such as RARYGB. The hand-sewn technique may offer important advantages in terms of shorter learning curve, reduced conversion rate, and lower leakage rate.
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Affiliation(s)
- Roberto Bustos
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Alberto Mangano
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Federico Gheza
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Liaohai Chen
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Gabriela Aguiluz-Cornejo
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Antonio Gangemi
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Lisa Sanchez-Johnsen
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Chandra Hassan
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Mario Masrur
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
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Hesse U, Lenz J, Thumfart L, Stein H. [Minimally invasive robot-assisted gastric bypass after open Mason reduction gastroplasty]. Chirurg 2019; 89:793-797. [PMID: 30135966 DOI: 10.1007/s00104-018-0700-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The introduction of robot-assisted surgery in the treatment of morbidly obese patients has enlarged the armamentarium for surgeons involved in bariatric surgery. This article describes the experiences with a conversion surgery from a complicated open Mason gastroplasty to a Roux en Y gastric bypass using the da Vinci Xi robotic system. CASE A 29-year-old female patient underwent a Mason reduction gastroplasty by laparotomy in 1995 (body mass index BMI 53.2 kg/m2). The course was complicated with a revision due to abscess formation and subsequent secondary healing. In 1996 an open revision of the gastroplasty due to persisting gastroesophageal reflux disease and outlet stenosis with dilatation of the outlet and an open cholecystectomy for cholecystolithiasis were performed . Abdominoplasty was performed for skin flaps in 2001 after the patient had lost 68 kg in weight. The patient presented at our hospital because of insufficient weight reduction even with weight gain since 2001 and treatment-refractive gastroesophageal reflux with adhesion problems. Clinical examination revealed normal scar tissue formation with no indications for an incisional hernia. The BMI was 48.2 kg/m2 with a body weight of 124 kg. The surgery was performed using a da Vinci Xi robotic system after access via a blunt dissection with the introduction of two trocars and adhesiolysis. The gastric pouch was created using Echelon 60 mm cartridges via an additional trocar. The gastroenterostomy was constructed with a 150 cm alimentary loop and a 60 cm biliodigestive loop resulting in a Roux en Y bypass. The operating time was 224 min. RESULTS The postoperative course was uneventful. Enteral nutrition was resumed on day 2 and the patient was discharged from the hospital 4 days postoperation. CONCLUSION This preliminary experience suggests that robotic revisional surgery can be performed safely even after complicated bariatric operations.
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Affiliation(s)
- U Hesse
- Adipositas- und metabolische Chirurgie Klinik für Allgemein‑, Viszeral und Thoraxchirurgie Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathanstr. 1, 90419, Nürnberg, Deutschland.
| | - J Lenz
- Adipositas- und metabolische Chirurgie Klinik für Allgemein‑, Viszeral und Thoraxchirurgie Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathanstr. 1, 90419, Nürnberg, Deutschland
| | - L Thumfart
- Adipositas- und metabolische Chirurgie Klinik für Allgemein‑, Viszeral und Thoraxchirurgie Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathanstr. 1, 90419, Nürnberg, Deutschland
| | - H Stein
- Adipositas- und metabolische Chirurgie Klinik für Allgemein‑, Viszeral und Thoraxchirurgie Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathanstr. 1, 90419, Nürnberg, Deutschland
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Less Morbidity with Robot-Assisted Gastric Bypass Surgery than with Laparoscopic Surgery? Obes Surg 2018; 29:519-525. [DOI: 10.1007/s11695-018-3545-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Wang L, Yao L, Yan P, Xie D, Han C, Liu R, Yang K, Guo T, Tian L. Robotic Versus Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity: a Systematic Review and Meta-Analysis. Obes Surg 2018; 28:3691-3700. [DOI: 10.1007/s11695-018-3458-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Beckmann JH, Aselmann H, Egberts JH, Bernsmeier A, Laudes M, Becker T, Schafmayer C, Ahrens M. [Robot-assisted vs laparoscopic gastric bypass : First experiences with the DaVinci system in bariatric surgery]. Chirurg 2018; 89:612-620. [PMID: 29589076 DOI: 10.1007/s00104-018-0629-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Conventional laparoscopy is the gold standard in bariatric surgery. Internationally, robot-assisted surgery is gaining in importance. Up to now there are only few reports from Germany on the use of the system in bariatric surgery. Since January 2017 we have been performing robot-assisted gastric bypass surgery. It remains unclear whether the use of the robotic system has advantages over the well-established laparoscopic technique. Within a period from January to early August 2017 a total of 53 gastric bypass operations were performed. Of these 16 proximal redo Roux-en-Y gastric bypass operations were performed with the DaVinci Si system versus 29 laparoscopic procedures. A retrospective analysis of the perioperative course was carried out. Body weight, body mass index (BMI), Edmonton obesity staging system (EOSS) and American Society of Anesthesiologists (ASA) classification did not show significant differences. There were also no significant differences in terms of estimated blood loss, intraoperative complications, duration of surgery, postoperative inflammatory parameters and weight loss. There was no mortality and no need for revisional surgery in either group. After laparoscopic surgery there was a delayed occurrence of a leak of the gastrojejunostomy followed by readmission and endoscopic negative pressure wound therapy. The results show that the proximal Roux-en-Y gastric bypass can be performed safely and efficiently using the DaVinci surgical system. Significant differences to the conventional laparoscopic procedure were not found. Larger randomized controlled trials are needed to define the role of the DaVinci system in bariatric surgery.
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Affiliation(s)
- J H Beckmann
- Klinik für Allgemeine, Viszeral‑, Transplantations‑, Thorax- und Kinderchirurgie, Universitätsklinikum Schleswig- Holstein, Campus Kiel, Arnold Heller Straße 3, 24105, Kiel, Deutschland.
| | - H Aselmann
- Klinik für Allgemeine, Viszeral‑, Transplantations‑, Thorax- und Kinderchirurgie, Universitätsklinikum Schleswig- Holstein, Campus Kiel, Arnold Heller Straße 3, 24105, Kiel, Deutschland
| | - J H Egberts
- Klinik für Allgemeine, Viszeral‑, Transplantations‑, Thorax- und Kinderchirurgie, Universitätsklinikum Schleswig- Holstein, Campus Kiel, Arnold Heller Straße 3, 24105, Kiel, Deutschland
| | - A Bernsmeier
- Klinik für Allgemeine, Viszeral‑, Transplantations‑, Thorax- und Kinderchirurgie, Universitätsklinikum Schleswig- Holstein, Campus Kiel, Arnold Heller Straße 3, 24105, Kiel, Deutschland
| | - M Laudes
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig- Holstein, Campus Kiel, Kiel, Deutschland
| | - T Becker
- Klinik für Allgemeine, Viszeral‑, Transplantations‑, Thorax- und Kinderchirurgie, Universitätsklinikum Schleswig- Holstein, Campus Kiel, Arnold Heller Straße 3, 24105, Kiel, Deutschland
| | - C Schafmayer
- Klinik für Allgemeine, Viszeral‑, Transplantations‑, Thorax- und Kinderchirurgie, Universitätsklinikum Schleswig- Holstein, Campus Kiel, Arnold Heller Straße 3, 24105, Kiel, Deutschland
| | - M Ahrens
- Klinik für Allgemeine, Viszeral‑, Transplantations‑, Thorax- und Kinderchirurgie, Universitätsklinikum Schleswig- Holstein, Campus Kiel, Arnold Heller Straße 3, 24105, Kiel, Deutschland
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Smeenk RM, van 't Hof G, Elsten E, Feskens PGBM. The Results of 100 Robotic Versus 100 Laparoscopic Gastric Bypass Procedures: a Single High Volume Centre Experience. Obes Surg 2018; 26:1266-73. [PMID: 26467691 DOI: 10.1007/s11695-015-1933-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The introduction of robotics in bariatric surgery is a novel development since the beginning of this century. The aim of this study is to compare surgical outcome of the robotic gastric bypass with the laparoscopic counterpart. METHODS A retrospective study was conducted to compare the results of 100 fully robotic gastric bypasses (RGB) and 100 laparoscopic gastric bypasses (LGB) performed by a single surgeon. Surgical outcome was analysed by evaluating operation room time and surgical time, morbidity and mortality, and length of hospital stay. RESULTS In the RGB and LGB group, respectively, 92 and 80 % of operated patients were female (p = 0.024). Mean age was 39 (range 20-62, SD 10.21) and 42 years (range 18-65, SD 11.87), respectively (p = 0.158). Mean BMI was 40 (range 35-47, SD 2.66) and 42 (range 35-56, SD 4.75), respectively (p < 0.05). Mean surgical time was 67 (range 39-210, SD 22.46) and 31 min (range 18-62, SD 9.12), respectively (p < 0.05). Mean operation room time was 117 (range 80-257, SD 30.13) and 66 min (range 38-101, SD 12.68), respectively (p < 0.05). The surgery-related 30-day morbidity rate was 5 % in both groups. Major morbidity (Clavien-Dindo class 3-4) was 3 and 1 %, respectively (p = 0.62). There was no mortality. Median hospital stay was two postoperative days in both groups. A learning curve developed after 25 procedures. CONCLUSIONS The RGB is a feasible procedure. Although more time is needed, a standardized technique results in fair operation times in the hands of an experienced surgeon.
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Affiliation(s)
- R M Smeenk
- Department of Bariatric Surgery, Bariatric Centre South-West Netherlands, Bravis Hospital, Bergen op Zoom, The Netherlands.
| | - G van 't Hof
- Department of Bariatric Surgery, Bariatric Centre South-West Netherlands, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - E Elsten
- Department of Bariatric Surgery, Bariatric Centre South-West Netherlands, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - P G B M Feskens
- Department of Bariatric Surgery, Bariatric Centre South-West Netherlands, Bravis Hospital, Bergen op Zoom, The Netherlands
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Roh HF, Nam SH, Kim JM. Robot-assisted laparoscopic surgery versus conventional laparoscopic surgery in randomized controlled trials: A systematic review and meta-analysis. PLoS One 2018; 13:e0191628. [PMID: 29360840 PMCID: PMC5779699 DOI: 10.1371/journal.pone.0191628] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/14/2017] [Indexed: 12/22/2022] Open
Abstract
Importance This review provides a comprehensive comparison of treatment outcomes between robot-assisted laparoscopic surgery (RLS) and conventional laparoscopic surgery (CLS) based on randomly-controlled trials (RCTs). Objectives We employed RCTs to provide a systematic review that will enable the relevant community to weigh the effectiveness and efficacy of surgical robotics in controversial fields on surgical procedures both overall and on each individual surgical procedure. Evidence review A search was conducted for RCTs in PubMed, EMBASE, and Cochrane databases from 1981 to 2016. Among a total of 1,517 articles, 27 clinical reports with a mean sample size of 65 patients per report (32.7 patients who underwent RLS and 32.5 who underwent CLS), met the inclusion criteria. Findings CLS shows significant advantages in total operative time, net operative time, total complication rate, and operative cost (p < 0.05 in all cases), whereas the estimated blood loss was less in RLS (p < 0.05). As subgroup analyses, conversion rate on colectomy and length of hospital stay on hysterectomy statistically favors RLS (p < 0.05). Conclusions Despite higher operative cost, RLS does not result in statistically better treatment outcomes, with the exception of lower estimated blood loss. Operative time and total complication rate are significantly more favorable with CLS.
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Affiliation(s)
- Hyunsuk Frank Roh
- Department of Biomedical Science, Hanyang University College of Medicine and Graduate School of Biomedical Science and Engineering, Seoul, Korea
- Department of Microbiology and Biomedical Science, Hanyang University College of Medicine and Graduate School of Biomedical Science and Engineering, Seoul, Korea
| | - Seung Hyuk Nam
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Guri, Gyunggi, Korea
| | - Jung Mogg Kim
- Department of Microbiology and Biomedical Science, Hanyang University College of Medicine and Graduate School of Biomedical Science and Engineering, Seoul, Korea
- * E-mail:
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Sharma G, Strong AT, Tu C, Brethauer SA, Schauer PR, Aminian A. Robotic platform for gastric bypass is associated with more resource utilization: an analysis of MBSAQIP dataset. Surg Obes Relat Dis 2017; 14:304-310. [PMID: 29276076 DOI: 10.1016/j.soard.2017.11.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND The current literature comparing robot-assisted Roux-en-Y gastric bypass (RA-RYGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) is limited to single center retrospective series. OBJECTIVES This study aims to compare perioperative outcomes of patients who underwent RA-RYGB with those who underwent LRYGB. SETTING National database. METHODS Data on patients who underwent RA-RYGB and LRYGB were extracted from the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participant use file. A 1:8 propensity score matching (RA-RYGB:LRYGB) was performed, and the 30-day outcomes of the propensity-matched cohorts were compared. RESULTS In total, 36,158 patients met inclusion criteria, including 2660 RA-RYGB (7.4%) cases, which were propensity matched (1:8) with 21,280 LRYGB cases having similar preoperative characteristics. RA-RYGB was associated with longer median operative time (136 versus 107 min; P<.001) and a higher 30-day readmission rate (7.3% versus 6.2%; P = .03). There were no statistical differences between the RA-RYGB and LRYGB cohorts with respect to all-cause morbidity (10.6% versus 10.7%; P = .8), serious morbidity (1.2% versus 1.7%; P = .07), mortality (0.1% versus .2%; P = .2), unplanned intensive care unit admission (1.1% versus 1.3%; P = .3), reoperation (2.4% versus 2.4%; P = .97), or reintervention (3.0% versus 2.5%; P = .2) within 30 days after surgery. CONCLUSION Based on available national data, RA-RYGB appears safe compared with a conventional laparoscopic approach for gastric bypass. However, RA-RYGB was associated with longer operative time and higher readmission rate, indicating greater resource use. Further studies are needed to better delineate the role of robotic platforms in bariatric surgery.
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Affiliation(s)
- Gautam Sharma
- Metabolic and Bariatric Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Andrew T Strong
- Metabolic and Bariatric Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Chao Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stacy A Brethauer
- Metabolic and Bariatric Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Philip R Schauer
- Metabolic and Bariatric Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ali Aminian
- Metabolic and Bariatric Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.
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Slim K, Canis M. [Robotic surgery. Can we (must we) swim against the current?]. Presse Med 2017; 46:557-560. [PMID: 28549628 DOI: 10.1016/j.lpm.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 04/11/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Karem Slim
- CHU Estaing, service de chirurgie digestive, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
| | - Michel Canis
- CHU Estaing, service de gynécologie et d'obstétrique, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
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Jung MK, Hagen ME, Buchs NC, Buehler LH, Morel P. Robotic bariatric surgery: A general review of the current status. Int J Med Robot 2017; 13. [DOI: 10.1002/rcs.1834] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 03/11/2017] [Accepted: 04/04/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Minoa K. Jung
- Division of Digestive and Transplant Surgery; Department of Surgery; University Hospital Geneva; Geneva Switzerland
| | - Monika E. Hagen
- Division of Digestive and Transplant Surgery; Department of Surgery; University Hospital Geneva; Geneva Switzerland
| | - Nicolas C. Buchs
- Division of Digestive and Transplant Surgery; Department of Surgery; University Hospital Geneva; Geneva Switzerland
| | - Leo H. Buehler
- Division of Digestive and Transplant Surgery; Department of Surgery; University Hospital Geneva; Geneva Switzerland
| | - Philippe Morel
- Division of Digestive and Transplant Surgery; Department of Surgery; University Hospital Geneva; Geneva Switzerland
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Robotic Versus Laparoscopic Bariatric Surgery: a Systematic Review and Meta-Analysis. Obes Surg 2016; 26:3031-3044. [DOI: 10.1007/s11695-016-2408-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Robotic vs. Laparoscopic Roux-En-Y Gastric Bypass: a Systematic Review and Meta-Analysis. Obes Surg 2016; 25:2180-9. [PMID: 26344797 DOI: 10.1007/s11695-015-1870-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
We aim to summarize the available literature on patients treated with robotic RYGB and compare the clinical outcomes of patients treated with robotic RYGB with those treated with the standard laparoscopic RYGB. A systematic literature search of PubMed and Scopus databases was conducted in accordance with the PRISMA guidelines. Fourteen comparative and 11 non-comparative studies were included in this study, reporting data on 5145 patients. This study points to comparable clinical outcomes between robotic and laparoscopic RYGB. Robotic-assisted RYGB was associated with significantly less frequent anastomotic stricture events, reoperations, and a decreased length of hospital stay compared with the standard laparoscopic procedures; however, these findings should be interpreted with caution given the low number and poor quality of the studies currently available in the literature.
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Tan A, Ashrafian H, Scott AJ, Mason SE, Harling L, Athanasiou T, Darzi A. Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and meta-analysis of the first 30 years. Surg Endosc 2016; 30:4330-52. [PMID: 26895896 PMCID: PMC5009165 DOI: 10.1007/s00464-016-4752-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/11/2016] [Indexed: 12/14/2022]
Abstract
Background Robotic surgery has been in existence for 30 years. This study aimed to evaluate the overall perioperative outcomes of robotic surgery compared with open surgery (OS) and conventional minimally invasive surgery (MIS) across various surgical procedures. Methods MEDLINE, EMBASE, PsycINFO, and ClinicalTrials.gov were searched from 1990 up to October 2013 with no language restriction. Relevant review articles were hand-searched for remaining studies. Randomised controlled trials (RCTs) and prospective comparative studies (PROs) on perioperative outcomes, regardless of patient age and sex, were included. Primary outcomes were blood loss, blood transfusion rate, operative time, length of hospital stay, and 30-day overall complication rate. Results We identified 99 relevant articles (108 studies, 14,448 patients). For robotic versus OS, 50 studies (11 RCTs, 39 PROs) demonstrated reduction in blood loss [ratio of means (RoM) 0.505, 95 % confidence interval (CI) 0.408–0.602], transfusion rate [risk ratio (RR) 0.272, 95 % CI 0.165–0.449], length of hospital stay (RoM 0.695, 0.615–0.774), and 30-day overall complication rate (RR 0.637, 0.483–0.838) in favour of robotic surgery. For robotic versus MIS, 58 studies (21 RCTs, 37 PROs) demonstrated reduced blood loss (RoM 0.853, 0.736–0.969) and transfusion rate (RR 0.621, 0.390–0.988) in favour of robotic surgery but similar length of hospital stay (RoM 0.982, 0.936–1.027) and 30-day overall complication rate (RR 0.988, 0.822–1.188). In both comparisons, robotic surgery prolonged operative time (OS: RoM 1.073, 1.022–1.124; MIS: RoM 1.135, 1.096–1.173). The benefits of robotic surgery lacked robustness on RCT-sensitivity analyses. However, many studies, including the relatively few available RCTs, suffered from high risk of bias and inadequate statistical power. Conclusions Our results showed that robotic surgery contributed positively to some perioperative outcomes but longer operative times remained a shortcoming. Better quality evidence is needed to guide surgical decision making regarding the precise clinical targets of this innovation in the next generation of its use.
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Affiliation(s)
- Alan Tan
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK.
| | - Alasdair J Scott
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
| | - Sam E Mason
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
| | - Leanne Harling
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
- Institute of Global Health Innovation, Imperial College London, London, SW7 2NA, UK
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Acquafresca PA, Palermo M, Rogula T, Duza GE, Serra E. Most common robotic bariatric procedures: review and technical aspects. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2015; 9:9. [PMID: 26516344 PMCID: PMC4624655 DOI: 10.1186/s13022-015-0019-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/13/2015] [Indexed: 12/19/2022]
Abstract
Since its appear
in the year 1997, when Drs. Cadiere and Himpens did the first robotic cholecystectomy in Brussels, not long after the first cholecystectomy, they performed the first robotic bariatric procedure. It is believed that robotically-assisted surgery’s most notable contributions are reflected in its ability to extend the benefits of minimally invasive surgery to procedures not routinely performed using minimal access techniques. We describe the 3 most common bariatric procedures done by robot. The main advantages of the robotic system applied to the gastric bypass appear to be better control of stoma size, avoidance of stapler costs, elimination of the potential for oropharyngeal and esophageal trauma, and a potential decrease in wound infection. While in the sleeve gastrectomy and adjustable gastric banding its utility is more debatable, giving a bigger advantage during surgery on patients with a very large BMI or revisional cases.
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Affiliation(s)
- Pablo A Acquafresca
- Division of Bariatric Surgery, CIEN-DIAGNOMED, Affiliated to the University of Buenos Aires, Av. Pte. Perón 10298 Ituzaingo, CP 1714 Buenos Aires, Argentina
| | - Mariano Palermo
- Division of Bariatric Surgery, CIEN-DIAGNOMED, Affiliated to the University of Buenos Aires, Av. Pte. Perón 10298 Ituzaingo, CP 1714 Buenos Aires, Argentina
| | - Tomasz Rogula
- Cleveland Clinic Foundation, Bariatric and Metabolic Institute, Cleveland, OH USA
| | - Guillermo E Duza
- Division of Bariatric Surgery, CIEN-DIAGNOMED, Affiliated to the University of Buenos Aires, Av. Pte. Perón 10298 Ituzaingo, CP 1714 Buenos Aires, Argentina
| | - Edgardo Serra
- Division of Bariatric Surgery, CIEN-DIAGNOMED, Affiliated to the University of Buenos Aires, Av. Pte. Perón 10298 Ituzaingo, CP 1714 Buenos Aires, Argentina
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SAGES TAVAC safety and effectiveness analysis: da Vinci ® Surgical System (Intuitive Surgical, Sunnyvale, CA). Surg Endosc 2015. [PMID: 26205559 DOI: 10.1007/s00464-015-4428-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The da Vinci(®) Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is a computer-assisted (robotic) surgical system designed to enable and enhance minimally invasive surgery. The Food and Drug Administration (FDA) has cleared computer-assisted surgical systems for use by trained physicians in an operating room environment for laparoscopic surgical procedures in general, cardiac, colorectal, gynecologic, head and neck, thoracic and urologic surgical procedures. There are substantial numbers of peer-reviewed papers regarding the da Vinci(®) Surgical System, and a thoughtful assessment of evidence framed by clinical opinion is warranted. METHODS The SAGES da Vinci(®) TAVAC sub-committee performed a literature review of the da Vinci(®) Surgical System regarding gastrointestinal surgery. Conclusions by the sub-committee were vetted by the SAGES TAVAC Committee and SAGES Executive Board. Following revisions, the document was evaluated by the TAVAC Committee and Executive Board again for final approval. RESULTS Several conclusions were drawn based on expert opinion organized by safety, efficacy, and cost for robotic foregut, bariatric, hepatobiliary/pancreatic, colorectal surgery, and single-incision cholecystectomy. CONCLUSIONS Gastrointestinal surgery with the da Vinci(®) Surgical System is safe and comparable, but not superior to standard laparoscopic approaches. Although clinically acceptable, its use may be costly for select gastrointestinal procedures. Current data are limited to the da Vinci(®) Surgical System; further analyses are needed.
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Svoboda S, Qaqish TR, Wilson A, Park H, Youssef Y. Robotic single-site cholecystectomy in the obese: outcomes from a single institution. Surg Obes Relat Dis 2015; 11:882-5. [DOI: 10.1016/j.soard.2014.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/14/2014] [Accepted: 09/20/2014] [Indexed: 12/12/2022]
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Alibhai MH, Shah SK, Walker PA, Wilson EB. A review of the role of robotics in bariatric surgery. J Surg Oncol 2015; 112:279-83. [PMID: 25953149 DOI: 10.1002/jso.23913] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 03/08/2015] [Indexed: 01/01/2023]
Abstract
The epidemic of obesity continues to be a major health issue. It is now almost uniform that surgical procedures for weight loss are performed with minimally invasive techniques. This article reviews the literature regarding obesity-related health issues, in particular risk of malignancy, and the application of robotic technology in weight loss surgical procedures. With increasing literature and technology in surgical robotics, its application in the field of bariatric surgery continues to evolve.
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Affiliation(s)
- Mustafa H Alibhai
- Department of Surgery, University of Texas Medical School at Houston, Houston, Texas
| | - Shinil K Shah
- Department of Surgery, University of Texas Medical School at Houston, Houston, Texas.,Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Device, Texas A&M University, College Station, Texas
| | - Peter A Walker
- Department of Surgery, University of Texas Medical School at Houston, Houston, Texas
| | - Erik B Wilson
- Department of Surgery, University of Texas Medical School at Houston, Houston, Texas
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Abstract
INTRODUCTION The growth of bariatric surgery has resulted in varying types of procedures with increasing complexity. Robotic digital platforms are employed in bariatric surgery to address this increasing complexity in the high-risk obese patient population with difficult anatomy. MATERIALS AND METHODS This review explores the literature and examines the reported outcomes and complications in using robotics for bariatric surgery. Robotic approaches to adjustable gastric banding, sleeve gastrectomy, gastric bypass, and biliopancreatic diversion with duodenal switch are examined. Revisional cases, learning curves, and cost effectiveness are reviewed, with an eye toward the future of bariatric surgery as the use of robotics is adopted. CONCLUSION Digital platforms are showing great promise as enabling technology which advance bariatric outcomes. With increasingly complex bariatric cases being performed and revised, the insertion of digital information between the surgeon and the patient leads to better operations for the patient and the surgeon.
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Affiliation(s)
- Erik B Wilson
- Department of Surgery, University of Texas Health Science Center at Houston, 6431 Fannin Street, Suite, 4.200, Houston, TX, 77030, USA,
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