Robotic Surgery

Robotic Bariatric Surgery, Obesity and Weight Loss  

 

Robotic Bariatric Surgery

Gastric Bypass surgery is increasingly being performed with the help of the surgical robotic system, which consists of a ‘slave’ cart with one camera arm and 3 robotic arms (left) to control the robotic instruments inserted through 7 mm robotic ports. The 4 robotic arms are controlled by the surgeon who sits at the robotic ‘master’ console (pictured at the foot of the page).

Robotic Fig 1The advantages of the robot in minimally invasive (‘keyhole’) surgery are well established. The system offers 3D vision, as opposed to the two dimensional views in standard laparoscopic surgery and improved precision due to the ability of the robotic system to remove any natural hand tremor of the operating surgeon and to scale down large movements to fine, precise movements.

Increasingly, robotic bariatric surgery is being seen as the ‘gold standard’ in this field and we are very proud to be at the forefront of these techniques in the UK.

Greater Precision

Notably, the robotic instruments have ‘wrists’ which means that the surgeon’s hand movements are completely and accurately reproduced by the robotic instruments (right).Robotic Fig 3

It is as if the surgeon can do the operation with his own hands but through tiny, 7mm incisions. All these features greatly improve precision and performance.

Suitability

Procedures such as the Gastric Bypass are especially suited to robotic surgery as this procedure involves a considerable amount of stitching. Improved visualization and greater precision means that stitching can be performed more safely with the robot.

Significantly, the ‘wristed’ robotic instruments facilitate stitching with both the dominant and the non-dominant hands with equal precision making stitching at difficult angles, frequently encountered in obese patients, more precise, effective and safer. All these features result in further lowering the risks and improving the outcome.

The robot is particular advantageous when operating on obese patients as the considerable thickness of the abdominal wall can induce fatigue in the surgeon and thus increase the risk of errors. Thus it maybe possible to perform a gastric bypass on patients with a higher BMI (>60) rather than offer them a laparoscopic sleeve gastrectomy.

The robot is also more beneficial than standard laparoscopy in revisional weight loss surgery (conversion from one procedure to another for eg. Band to Bypass) as an anastomosis that is completely sutured is associated with a lower riskRobotic Fig 2 of complications than one that is completed with a stapler. With an increa
sing demand for these revision procedures, the robot has an important role to play in reducing complications.

The Cosmetic Result

The resulting cosmetic result after a robotic procedure is also better than standard laparoscopy are the incisions are smaller and are placed more in the sides rather than the front of the abdomen and are less visible.

The robotic platform is ideal for the performance of single incision or ‘scarless’ surgery as the robotic instruments will address some of the current problems with single-incision surgery.

 

Case Study

TK (name changed) is a 39- year old lady who started becoming overweight when she had her first child and continued to gain more weight over the subsequent 2 pregnancies. She had tried to lose weight through various diets and had been successful in losing 12.5 kg (2 stones) on two separate occasions in the year preceding her referral for weight loss surgery but found that she gained all the weight she had lost. She suffered with high blood pressure for which she was on two medications.

She met various members of the multidisciplinary team and decided to undergo the gastric bypass procedure. On being informed about the benefits of robotic surgery, she was keen to undergo the robotic gastric bypass. She underwent the procedure without any complications and was discharged the next day after an overnight stay in hospital.

3 months after surgery she is extremely pleased with the outcome of her surgery – her weight has reduced by 19 kg (3 stones), her scars have healed well and are barely noticeable.

 

Next: Comparison of the Techniques