The Evolution of Robotic Bariatric Surgery

Abstract

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.

Risk Factors for Postoperative Morbidity After Totally Robotic Gastric Bypass in 302 Consecutive Patients

“…Consequently, postoperative morbidity rate has been reported from 11 to 38 % when RYGBP is performed after vertical banded gastroplasty (VBG) and from 6 to 46 % after adjustable gastric banding (AGB) [32][33][34][35][36][37][38][39][40][41]. In this setting, the robotic approach has been proposed to perform RYGBP after failed previous bariatric surgical procedures because it is considered to be associated with improved postoperative morbidity in comparison with conventional laparoscopic or open approaches [2,22,29,31,40,42]. Hence, Buchs et al reported that robotic group patients had no postoperative complications whereas postoperative morbidity rates were 14.3 and 10.7 % after conventional laparoscopic and open revisional RYGBP, respectively [42].…”

“…As a majority of new available technologies, R-RYGBP has been adopted in some centers on the basis of large single-and multi-institutional retrospective experiences [3]. We believe this data may not be sufficient to justify the higher cost due to the routine use of a robotic system to perform a gastric bypass in a morbidly obese patient [2,3,8,12]. Furthermore, it is now unjustifiable that new technologies are adopted without a robust system of post marketing surveillance and professional oversight to evaluate safety, efficacy, and cost [1].…”

“…In this regard, it has been recently proposed to use the robotic system in more complex bariatric cases only, i.e., in patients with previous abdominal and bariatric surgical procedures [13,14]. Despite several groups having reported low postoperative morbidity and mortality rates after R-RYGBP, risk factors for postoperative morbidity have never been evaluated in large studies [2,3,8,12]. As a bariatric group, we have begun a dedicated prospective effort to evaluate the safety, feasibility, and reliability of a computerassisted robotic platform in bariatric surgery since 2007 [13,14].…”

“…Bariatric surgical procedures using robotic platforms have become a common practice in many bariatric surgery programs with totally robotic Roux-en-Y gastric bypass (R-RYGBP) as the most frequently performed technique in those centers [1][2][3][4][5]. However, the conventional transperitoneal laparoscopic approach remains the standard of care worldwide when performing gastric bypass (RYGBP) and its results should be used when evaluating the role of R-RYGBP [6][7][8][9][10][11].…”

Resultados iniciais da primeira série de casos brasileira de cirurgia bariátrica totalmente robótica

“…Since its military applicability did not develop as initially expected, robotic surgery technology was modified towards the development of equipment which could align the excellent quality of high definition 3-D image, the intuitive movements of the open surgery and the precision, refinement and minimally invasive aspects of laparoscopic surgery. This combination seems to be very useful and beneficial in advanced and complex gastrointestinal surgeries, such as bariatric surgery 14,29 . The first reports on the use of robotic technology in surgery encompassed the hybrid technique ("robot-assisted") where the robot was used in only part in the conventional laparoscopy, mainly in the anastomoses.…”