[Robotic pylorus-preserving pancreaticoduodenectomy : Video article]

Using the da Vinci X® - System for Esophageal Surgery

Robotic esophageal surgery is becoming more widely adopted. Several publications on the feasibility, short-term outcomes and technical aspects are available. Most of these articles used either the da Vinci® SI system or in newer series the Xi System. The da Vinci® X system is generally considered less suited for multiquadrant access like in esophageal surgery, hence only limited data is available. Here we describe our initial experience with 16 Ivor-Lewis robotic assisted minimally invasive esophagectomies (RAMIE) in patients with esophageal adenocarcinoma. The da Vinci® X system was installed in our department in 2019; the robotic program comprises colorectal, pancreatic and esophageal surgery. The first two patients were operated in the presence of a proctor. An operative standard was established including fluorescence angiography (Firefly®). Technical aspects with focus on the characteristics of the da Vinci® X system, operating room setup, and short-term outcomes are discussed.

Robotic Roux-en-Y Gastric Bypass Procedure Guide

Purpose

This is a step-by-step procedural guide to help new and unexperienced surgeons with the implementation of a robotic program for the surgical treatment of morbid obesity.

Methods

Based on our vast robotic experience, we present our standardized technique and also, with a PubMed research, discuss the different surgical aspects.

Results

We present our trainings pathway towards the first robotic Roux-en-Y gastric bypass, a step-by-step procedural guide with helpful hints when it comes to troubleshooting and also discuss some surgical aspects.

Conclusion

The robotic Roux-en-Y gastric bypass is safe and feasible, and might offer some advantages in comparison to the laparoscopic approach.

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

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.

[Robot-assisted vs laparoscopic gastric bypass : First experiences with the DaVinci system in bariatric surgery]

Conventional laparoscopy is the gold standard in bariatric surgery. Internationally, robot-assisted surgery is gaining in importance. Up to now there are only few reports from Germany on the use of the system in bariatric surgery. Since January 2017 we have been performing robot-assisted gastric bypass surgery. It remains unclear whether the use of the robotic system has advantages over the well-established laparoscopic technique. Within a period from January to early August 2017 a total of 53 gastric bypass operations were performed. Of these 16 proximal redo Roux-en-Y gastric bypass operations were performed with the DaVinci Si system versus 29 laparoscopic procedures. A retrospective analysis of the perioperative course was carried out. Body weight, body mass index (BMI), Edmonton obesity staging system (EOSS) and American Society of Anesthesiologists (ASA) classification did not show significant differences. There were also no significant differences in terms of estimated blood loss, intraoperative complications, duration of surgery, postoperative inflammatory parameters and weight loss. There was no mortality and no need for revisional surgery in either group. After laparoscopic surgery there was a delayed occurrence of a leak of the gastrojejunostomy followed by readmission and endoscopic negative pressure wound therapy. The results show that the proximal Roux-en-Y gastric bypass can be performed safely and efficiently using the DaVinci surgical system. Significant differences to the conventional laparoscopic procedure were not found. Larger randomized controlled trials are needed to define the role of the DaVinci system in bariatric surgery.