Reducing Cost of Surgery by Avoiding Complications: the Model of Robotic Roux-en-Y Gastric Bypass

Hagen, Monika; Pugin, François Louis; Chassot, Gilles; Huber, Olivier; Buchs, Nicolas; Iranmanesh, Pouya; Morel, Philippe

doi:10.1007/s11695-011-0422-1

Cited by 154 publications

(97 citation statements)

References 21 publications

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“…Robotic surgery is now being presented as a new tool that enhances safety, allows remote operation, and enables operations to be performed in a limited space 4. When compared to laparoscopic surgery, robotic surgery was found to be equivalent in selected urologic, gynecologic, and visceral operations 5, 6, 7, 8. Initial attempts to use robotic assistance in kidney transplantation were successful.…”

Section: Introductionmentioning

confidence: 99%

Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

Meier

Piller

Hagen

et al. 2018

American Journal of Transplantation

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Robot‐assisted kidney transplantation is feasible; however, concerns have been raised about possible increases in warm ischemia times. We describe a novel intra‐abdominal cooling system to continuously cool the kidney during the procedure. Porcine kidneys were procured by standard open technique. Groups were as follows: Robotic renal transplantation with (n = 11) and without (n = 6) continuous intra‐abdominal cooling and conventional open technique with intermittent 4°C saline cooling (n = 6). Renal cortex temperature, magnetic resonance imaging, and histology were analyzed. Robotic renal transplantation required a longer anastomosis time, either with or without the cooling system, compared to the open approach (70.4 ± 17.7 min and 74.0 ± 21.5 min vs. 48.7 ± 11.2 min, p‐values < 0.05). The temperature was lower in the robotic group with cooling system compared to the open approach group (6.5 ± 3.1°C vs. 22.5 ± 6.5°C; p = 0.001) or compared to the robotic group without the cooling system (28.7 ± 3.3°C; p < 0.001). Magnetic resonance imaging parenchymal heterogeneities and histologic ischemia–reperfusion lesions were more severe in the robotic group without cooling than in the cooled (open and robotic) groups. Robot‐assisted kidney transplantation prolongs the warm ischemia time of the donor kidney. We developed a novel intra‐abdominal cooling system that suppresses the noncontrolled rewarming of donor kidneys during the transplant procedure and prevents ischemia–reperfusion injuries.

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Section: Introductionmentioning

confidence: 99%

Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

Meier

Piller

Hagen

et al. 2018

American Journal of Transplantation

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“…Hagen et al calculated that as robotic gastric bypass is associated with lower complications, lower anastomotic leaks and less reoperations, the general cost for society even is lower than a laparoscopic gastric bypass. 12 Nowadays, the Da Vinci platform is still the only available one. The instruments are sold at a very high price.…”

Section: Discussionmentioning

confidence: 99%

Contemporary Role of Robotics in Bariatric Surgery: Experience of CUF Infante Santo Hospital

Reynvoet

Silva

Galindo

et al. 2018

Gaz Med

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INTRODUCTION:The use of robotics in bariatric surgery is increasing worldwide, with the main objective of reducing complications and optimising surgical outcome. This study presents a single centre 1.5-year experience and clinical outcome with robotic gastric bypass. METHODS: A retrospective review was performed of 42 consecutive patients who underwent a robotic gastric bypass. Patient files were analysed to obtain patient characteristics, weight loss results and per-and postoperative morbidity. RESULTS: In 32/42 patients, a primary gastric bypass was performed, the remaining 10 procedures were revision cases. Mean start weight was 111.1 (+/-20.5) kg, mean start BMI was 39.7 (+/-5.6) kg/m 2 . Almost half of the patients presented with pre-existing comorbidities. After a mean follow-up of 9.1 (+/-5.2) months, mean body mass index was 30.16 (+/-5.3) kg/m 2 with a percentage excess weight loss of 66.16 (+/-43.6)%. There were no conversions, no leaks and no mortality. Two patients presented with minor complications; one infected hematoma and one anastomotic ulcer. Mean length of stay in the hospital was 2.8 (2-5) days. All but one patients were satisfied with the weight loss result. CONCLUSION: The robotic gastric bypass is a safe and reproducible approach to treat morbid obesity. A secure handsewn gastrojejunal anastomosis, quick recovery and better ergonomics are the main advantages of this technique.

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“…However, the possible reduction in treatment of the complications such as stenosis, as well as not use some cartridges for the anastomoses, are factors which may also contribute to the cost reduction in robotic bariatric surgery 13 . The costs are still high, if it is included equipment acquisition and maintenance.…”

Section: Discussionmentioning

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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Reducing Cost of Surgery by Avoiding Complications: the Model of Robotic Roux-en-Y Gastric Bypass

Abstract: Robotic RYGBP can be cost effective due to balancing greater robotic overhead costs with the savings associated with avoiding stapler use and costly anastomotic complications.

Cited by 154 publications

References 21 publications

Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

Contemporary Role of Robotics in Bariatric Surgery: Experience of CUF Infante Santo Hospital

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

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