The procedure that benefits most from robotic assistance in the field of bariatric surgery is the gastric bypass. Our group currently uses the system to perform a robotic-assisted, hand-sewn gastrojejunostomy for completion of the laparoscopic Roux-en-Y gastric bypass procedure. The operative room is set up as shown in (Fig. 9.1). The first part of the opera tion is performed laparoscopically; a small pouch and a 120-cm limb are created. After this, the robot is put in place and a running two-layer, hand-sewn antecolic antegastric gastrojejunal anastomosis is performed. We believe that performing a hand-sewn anastomosis offers the best method to decrease the risk of leak. We recently completed analyzing the data of our robotic bariatric surgeon and a surgeon at an outside institution. Both surgeons were junior faculty and were well within the steep learning curve of the minimally invasive approach. They have now completed close to 200 procedures without an anastomotic leak. They have also experienced significantly fewer strictures than the 9-14% expected rate of circular stapler anastomotic techniques [7, 8]. Performing a hand-sewn anastomosis also eliminates the requirement of passing a stapler anvil down the esophagus (avoiding the risk of esopha-
geal injury) or adding an additional stapler line after passing the anvil transgastric. In addition, our survey of national robotic surgeons revealed that 107 cases of robotic-assisted Roux-en-Y gastric bypasses were performed by seven surgeons in the United States in 2003 . The main utility of the robotic system was found to be in creating the gastrojejunostomy, the articulating wrists, three-dimensional view, and motion scaling, allow a precise hand-sewn anastomosis  (Fig. 9.2). This was most notable in patients with a high basal metabolic rate ([BMI] greater than 60 or super obese) and/or those patients with an enlarged left hepatic lobe, which greatly decreases the working area beneath the liver. Regarding operative time, surgeons having an experience greater than 20 cases reported that preparation for the robot can be decreased to as little as 6 min and robotic work time can also diminish by 50% .
Our institutional experience and that of the surgeons who responded to our survey is that robotically assisted hand-sewn gastrojejunostomy is superior to any currently available minimally invasive anastomotic technique. This technique has the potential to diminish the leak, stricture, and mortality rates of this procedure . However, larger studies conducted in prospective
randomized fashion still need to be performed to verify our currently perceived clinical advantages.
Was this article helpful?
Virtual Gastric Band Hypnosis Audio Programm that teaches your mind to use only the right amount of food to keep you slim. The Virtual Gastric Band is applied using mind management techniques, giving you the experience of undergoing surgery to install a virtual gastric band or virtual lap-band, creating a small pouch at the top of the stomach which limits how much food can be eaten. Once installed, the Virtual Gastric Band creates the sensation of having a smaller stomach that is easily filled and satisfied with smaller amounts of food.