Use of barbed sutures in robotic bariatric bypass surgery: a single-center case series

Abstract

Background Surgical robots are increasingly being used in bariatric surgery. While several studies describe the safety of using barbed sutures in laparoscopic gastric bypass surgery, no reports are available for robotic bariatric procedures. The aim of our article is to determine whether barbed sutures can be used safely in robotic Roux-en-Y bypass (RYGB) surgery. Methods This was a single-center, single-surgeon case series of RYGB procedures using the da Vinci® Xi Surgical System (Intuitive Surgery, Sunnyvale, CA, USA) in combination with the use of barbed sutures (Stratafix, Ethicon, Johnson & Johnson, Cincinnati, OH, USA). Results Fifty robotic proximal and distal RYGB surgeries were performed. A linear stapled, side-to-side gastrojejunostomy was carried out, whereby the enterotomy was completed with a running resorbable unidirectional barbed suture, Stratafix 2–0. In one case after robotic proximal RYGB, revision surgery was required due to omentum necrosis. Another patient was readmitted due to gastrointestinal bleeding from anastomosis. No anastomotic insufficiencies, no stenoses, or higher-grade complications according to Clavien-Dindo 4a-5 were found. Conclusions We found that the use of self-fixing barbed sutures in robotic RYGB is safe. The self-fixing suture enables the robotic surgeon to perform a simple continuous suture without the need for recurrent retraction. Although we are the first to report this procedure, we had a low number of cases and no control group; thus, further studies with a higher level of evidence are required. Electronic supplementary material The online version of this article (10.1186/s12893-019-0563-z) contains supplementary material, which is available to authorized users.

Experience of a modified chest tube suture-fixation technique in uniportal thoracoscopic pulmonary resection

“…Several studies indicate that the suture yields satisfactory results in clinical practice [ 20 – 22 ]. The clinical efficacy and suitability of knotless barbed absorbable sutures have long been reported with remarkable benefits [ 23 – 27 ]. However, the Vicryl Plus material could yield better clinical outcomes due to the hard texture and the cost.…”

The Impact of Robotics in Learning Roux-en-Y Gastric Bypass: a Retrospective Analysis of 214 Laparoscopic and Robotic Procedures

“…In addition to the inpatient course, standardized follow-up data were collected after 1 month and 1 year. A subgroup consisting of 37 primary da Vinci Xi RYGB surgeries was published as single surgeon case series in 2019 [25].…”

“…Apart from the different trocar placements, the surgical techniques did not differ. The detailed procedure steps have been published previously [25]. In brief, a side-toside gastrojejunostomy was performed using a 45-mm linear stapler (Echelon Flex™ Endopath).…”

Pros and Cons of Robotic Revisional Bariatric Surgery

“…Besides a case report of a complex open revision operation [32], a subgroup of 13 rRRYGB operations was published as case series in 2019 [33].…”

“…The different index operations and indications required various surgical procedures. Standard LRYGB and RRYGB have already been described [9,33]. The da Vinci Xi robotic platform (Intuitive Surgical, Sunnyvale, CA, USA) was used for all robotic revisional procedures.…”