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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References
Krawczyk M (2017) Modern surgeons: still masters of their trade or just operators of medical equipment? Ann Surg 266(5):703–705
Acquafresca PA, Palermo M, Rogula T, Duza GE, Serra E (2015) Most common robotic bariatric procedures: review and technical aspects. Ann Surg Innov Res 28:9–19. https://doi.org/10.1186/s13022-015-0019-9
Bindal V, Bhatia P, Dudeja U, Kalhan S, Khetan M, John S, Wadhera S (2015) Review of contemporary role of robotics in bariatric surgery. J Minim Access Surg 1:16–21. https://doi.org/10.4103/0972-9941.147673
Tan A, Ashrafian H, Scott AJ, Mason SE, Harling L, Athanasiou T, Darzi A (2016) Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and meta-analysis of the first 30 years. Surg Endosc 10:4330–4352. https://doi.org/10.1007/s00464-016-4752-x (Epub 2016 Feb 19)
Knab LM, Zureikat AH, Zeh HJ III, Hogg ME (2017) Towards standardized robotic surgery in gastrointestinal oncology. Langenbeck’s Arch Surg 402:1003–1014
Sanchez BR, Mohr CJ, Morton JM, Safadi BY, Alami RS, Curet MJ (2005) Comparison of totally robotic laparoscopic Roux-en-Y gastric bypass and traditional laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 6:549–554
Gray KD, Moore MD, Elmously A, Bellorin O, Zarnegar R, Dakin G, Pomp A, Afaneh C (2018) Perioperative outcomes of laparoscopic and robotic revisional bariatric surgery in a complex patient population. Obes Surg 28:1852–1859
Beckmann JH, Mehdorn AS, Kersebaum JN, Schönfels W, Taivankhuu T, Laudes M, Egberts JH, Becker T (2020) Pros and cons of robotic revisional bariatric surgery. Visc Med 36:238–245
Dindo D, Demartins N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of survey. Ann Surg 240(2):205–213
Ecker BL, Maduka R, Ramdon A, Dempsey DT, Dumon KR, Williams NN (2016) Resident education in robotic-assisted vertical sleeve gastrectomy: outcomes and cost-analysis of 411 consecutive cases. Surg Obes Relat Dis 12:313–320. https://doi.org/10.1016/j.soard.2015.05.011 (Epub 2015 May 27)
Hesse U, Giulini L, Thumfahrt L, Stein H (2017) Einführung der Roboterunterstützten Minimalinvasiven Chirurgie (Da Vinci Xi) unter Einbeziehung der bariatrischen Chirurgie in einem Krankenhaus der Maximalversorgung. Érfahrung mit den ersten 100 Fällen. Zeitschrift für Gastroenterol 8:55. https://doi.org/10.1055/s-0037-1605315
Hesse U, Lenz J, Engel L, Dubecz A, Brucker C, Pahernik S, Stein H (2017) Implementation of the Da Vinci Xi robotic system to perform bariatric surgery in a maximum care hospital. Innov Surg Sci. https://doi.org/10.1515/iss-2001
Villamere J, Gebhart A, Vu S, Nguyen NT (2015) Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at Academic Medical Centers. Surg Endosc 29(7):1729–1736. https://doi.org/10.1007/s00464-014-3886-y (Epub 2014 Oct 16)
Hagen ME, Pugin F, Chassot G, Huber O, Buchs N, Iranmanesh P, Morel P (2012) Reducing cost of surgery by avoiding complications: the model of robotic Roux en-Y gastric bypass. Obes Surg 22:52–61. https://doi.org/10.1007/s11695-011-0422-1
Mees ST, Kirchberg J, Weitz J (2017) Robotik in der Chirurgie. Passion Chir 2:7
Vilallonga R, Fort JM, Gonzalez O, Caubet E, Boleko A, Neff KJ, Armengol M (2012) The initial learning curve for robot-assisted sleeve gastrectomy: a surgeon’s experience while introducing the robotic technology in a Bariatric Surgery Department. Minim Invasive Surg. https://doi.org/10.1155/2012/347131 (Epub 2012 Sep 17)
Ballantyne GH, Ewing D, Capella RF, Capella JF, Davis D, Schmidt HJ, Wasielewski A, Davies RJ (2005) The learning curve measured by operating times for laparoscopic and open gastric bypass: roles of surgeon’s experience, institutional experience, body mass index and fellowship training. Obes Surg 15(2):172–182
Hesse U, Lenz J, Thumfart L, Stein H (2018) Minimal invasive, roboterassistierte Magenbypassanlage nach offener Masongastroreduktionsplastik. Chirurg. https://doi.org/10.1007/s00104-018-0700-8
Ayloo SM, Choudhury N (2015) Robotic revisional bariatric surgery: single-surgeon case series. Int J Med Robot 11(3):284–289. https://doi.org/10.1002/rcs.1622 (Epub 2014 Oct 10)
Buchs NC, Pugin F, Azagury DE, Huber O, Chassot G, Morel P (2014) Robotic revisional bariatric surgery: a comparative study with laparoscopic and open surgery. Int J Med Robot 10(2):213–217. https://doi.org/10.1002/rcs.1549 (Epub 2013 Oct 24)
Hesse UJ, Lenz J, Vladimirov M, Giulini L, Dubecz A, Stein H (2021) Minimally invasive conversion of a gastric bypass into sleeve gastrectomy for postprandial hyperinsulinemic hypoglycemia. Obes Surg. https://doi.org/10.1007/s11695-021-05241-zU (in press)
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Hesse, U.J., Lenz, J., Dubecz, A. et al. Intraoperative conversion and complications in robotic assisted primary and redo gastric bypass surgery. J Robotic Surg 16, 235–239 (2022). https://doi.org/10.1007/s11701-021-01212-9
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DOI: https://doi.org/10.1007/s11701-021-01212-9