Experiência brasileira inicial em cirurgia da obesidade robô - assistida

Abdalla, René Jorge; Garcia, Rodrigo Biscuola; Luca, Claudia de; Costa, Rafael Izar Domingues da; Cozer, Claudia de Oliveira

doi:10.1590/s0102-67202012000100008

Cited by 12 publications

(3 citation statements)

References 7 publications

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“…The initial search produced 132 potentially relevant articles. After the titles and abstracts were screened for relevance, 25 remaining articles were further assessed for eligibility and 3 were excluded; 22 trials whose characteristics are reported in Tables 1 and 2 , were included in this systematic review: 1 Randomized Controlled Trial (RCT), 9 Clinical Controlled Trial (CCT) and 12 case series [ 7 , 8 , 15 - 34 ]. We excluded the abstract of the largest series trial of robotic-assisted bypass performed in three high-volume centers and presented by Wilson at the American Society for Metabolic & Bariatric Surgery Annual Meeting in San Diego (2012) due to the limited data available in the abstract.…”

Section: Resultsmentioning

confidence: 99%

Current status of robotic bariatric surgery: a systematic review

et al. 2013

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BackgroundBariatric surgery is an effective treatment to obtain weight loss in severely obese patients. The feasibility and safety of bariatric robotic surgery is the topic of this review.MethodsA search was performed on PubMed, Cochrane Central Register of Controlled Trials, BioMed Central, and Web of Science.ResultsTwenty-two studies were included. Anastomotic leak rate was 8.51% in biliopancreatic diversion. 30-day reoperation rate was 1.14% in Roux-en-Y gastric bypass and 1.16% in sleeve gastrectomy. Major complication rate in Roux-en-Y gastric bypass resulted higher than in sleeve gastrectomy ( 4,26% vs. 1,2%). The mean hospital stay was longer in Roux-en-Y gastric bypass (range 2.6-7.4 days).ConclusionsThe major limitation of our analysis is due to the small number and the low quality of the studies, the small sample size, heterogeneity of the enrolled patients and the lack of data from metabolic and bariatric outcomes. Despite the use of the robot, the majority of these cases are completed with stapled anastomosis. The assumption that robotic surgery is superior in complex cases is not supported by the available present evidence. The major strength of the robotic surgery is strongly facilitating some of the surgical steps (gastro-jejunostomy and jejunojejunostomy anastomosis in the robotic Roux-en-Y gastric bypass or the vertical gastric resection in the robotic sleeve gastrectomy).

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Section: Resultsmentioning

confidence: 99%

Current status of robotic bariatric surgery: a systematic review

et al. 2013

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“…In 2003, in a series of 211 cases of robot-assisted surgeries, the authors reported seven RYGB, those been the first reports of this type of bariatric surgery with the help of robotics 28 . In Brazil, the first report was published in 2012 about a case-series initiated in 2008, with 27 bariatric procedures, 16 of those having undergone RYGB, all of them with hybrid technique ("robotassisted") 1 . In many instances, the hybrid technique in bariatric surgery represented a preliminary step toward performing a totally robotic bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The institutions that perform bariatric surgery via robot in Brazil is still small since it demands large investment in equipment, structure adaptation and adequate training for the surgical team. The first Brazilian report in robotic bariatric surgery is a series of cases with the "hybrid" technique (robotassisted) 1 . To date, there is no Brazilian published report on totally robotic bariatric surgery.…”

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confidence: 99%

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

Ramos

Domene

Volpe

et al. 2013

ABCD, arq. bras. cir. dig.

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-Background: Currently, bariatric surgery is the most effective therapy for morbid obesity, and the laparoscopic approach is considered gold-standard for Rouxen-Y gastric bypass. Totally robotic Roux-en-Y gastric bypass has been proposed as a major evolution in minimally invasive bariatric surgery and its use is becoming more widespread. Aim: To provide an early report of the first Brazilian case-series of totally robotic gastric bypass and perioperative short-term outcomes. There was no mortality, leak or stricture. Conclusion: Even with surgeons in early learning curves, the robotic approach within a well-structured training model was safe and reproducible for the surgical treatment of the morbid obesity. RESUMO -Racional:Atualmente a cirurgia bariátrica é o tratamento mais eficaz para a obesidade mórbida. Embora ainda tenha algumas dificuldades, a abordagem laparoscópica tem-se tornando o padrão-ouro para o by-pass gástrico em Y-deRoux. O uso da robótica representa grande evolução no campo da cirurgia bariátrica minimamente invasiva e seu uso tem sido cada vez mais difundido. Objetivo: Relatar a primeira experiência brasileira em cirurgia bariátrica totalmente robótica. Métodos: Foram avaliados todos os pacientes submetidos à cirurgia bariátrica totalmente robótica em dois centros de excelência em cirurgia bariátrica. Foram registrados a incidência demográfica, índice de massa corporal, tempos operatórios, duração da internação hospitalar, mortalidade e todas as complicações em até 30 dias. As equipes cirúrgicas receberam treinamento específico para aprendizagem da técnica robótica e todos os procedimentos foram feitos com supervisão. Resultados: O procedimento foi realizado por cinco equipes cirúrgicas em 68 pacientes (52 mulheres -76,5%), com idade média de 40,5 anos e IMC médio de 41,3. O tempo médio operatório total foi de 158 minutos e a média de permanência hospitalar foi de 48 h. O percentual de complicações perioperatórias foi de 5,9%. Não houve mortalidade, fístulas ou estenoses. Conclusão: Mesmo com cirurgiões em período inicial da curva de aprendizagem, o by-pass gástrico por abordagem totalmente robótica é opção técnica segura e reproduzível no tratamento cirúrgico da obesidade mórbida, desde que respeitado modelo de treinamento bem estruturado.

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