Elsevier

Surgery for Obesity and Related Diseases

Volume 1, Issue 6, November–December 2005, Pages 549-554
Surgery for Obesity and Related Diseases

Original article
Comparison of totally robotic laparoscopic Roux-en-Y gastric bypass and traditional laparoscopic Roux-en-Y gastric bypass

https://doi.org/10.1016/j.soard.2005.08.008Get rights and content

Abstract

Background

Laparoscopic gastric bypass is a technically demanding operation, especially when hand-sewing is required. Robotics may help facilitate the performance of this difficult operation. This study was undertaken to compare a single surgeon’s results using the daVinci Surgical System with those using traditional laparoscopic Roux-en-Y gastric bypass (LRYGB) when the techniques were learned simultaneously.

Methods

From July 2004 to April 2005, the new laparoscopic fellow’s first 50 patients were randomized to undergo either LRYGB or totally robotic laparoscopic Roux-en-Y gastric bypass (TRRYGB). Data were collected on patient age, gender, body mass index (BMI), co-morbidities, operative time, complication rates, and length of stay. Student’s t test with unequal variances was used for statistical analysis.

Results

No significant differences in age, gender, co-morbidities, complication rates, or length of stay were found between the two groups. The mean operating time was significantly shorter for TRRYGB than for LRYGB (130.8 versus 149.4 minutes; P = 0.02), with a significant difference in minutes per BMI (2.94 versus 3.47 min/BMI; P = 0.02). The largest difference was in patients with a BMI >43 kg/m2, for whom the difference in procedure time was 29.6 minutes (123.5 minutes for TRRYGB versus 153.2 minutes for LRYGB; P = 0.009) and a significant difference in minutes per BMI (2.49 versus 3.24 min/BMI; P = 0.009).

Conclusion

Our data indicate that the use of the daVinci Surgical System for TRRYGB is safe and feasible. The operating room time is shorter with the use of the robotic system during a surgeon’s learning curve, and that decrease is maximized in patients with a larger BMI. TRRYGB may be a better approach to gastric bypass when hand-sewing is required, especially early in a surgeon’s experience.

Section snippets

Methods

From July 2004 to April 2005, the new laparoscopic fellow’s first 50 patients were randomized to undergo either TRRYGB or LRYGB. All patients met the minimal criteria for bariatric surgery proposed by the National Institute’s of Health Consensus Development Panel report of 1991 [5]. The technique of TRRYGB has been previously described by Mohr et al. [6] in 2005. The jejunojejunostomy anastomosis was created with an Endo-GIA stapler and the resultant jejunojejunostomy enterotomy and

Results

Fifty patients were randomized and underwent either TRRYGB or LRYGB performed by the laparoscopic fellow. No significant differences were found between the two groups with regard to age, gender, BMI, average number of prior abdominal operations, co-morbidities, and length of stay (Table 1). No major intraoperative complications arose. No conversions to open gastric bypass were needed. One patient in the TRRYGB group required oversewing of a small defect on the gastric pouch found by an

Discussion

Obesity is a serious public health problem in the United States, and the prevalence is growing every year. Since the Roux-en-Y gastric bypass (RYGB) was first described by Mason and Ito in 1967, it has become the “gold standard” for the surgical treatment of morbid obesity [9]. With the development of minimally invasive surgical techniques, the laparoscopic approach for RYGB has been one of the most important advances in modern bariatric surgery. Even so, laparoscopic surgery has placed real

Conclusion

Our data have indicated that the use of the daVinci Surgical System for TRRYGB is safe and feasible. The operating room time is decreased with the use of the robotic system during a surgeon’s learning curve, and this decrease is maximized in patients with larger BMIs. TRRYGB may be a better approach to gastric bypass when hand-sewing is required, especially early in a surgeon’s experience.

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