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Massala-Yila EF, Ali M, Yu W, Wang W, Ren J, Wang D. Evaluating body mass index's impact on Da Vinci Robotic rectal cancer surgery, a retrospective study. J Robot Surg 2024; 18:22. [PMID: 38217775 DOI: 10.1007/s11701-023-01774-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/14/2023] [Indexed: 01/15/2024]
Abstract
Robotic surgery addresses laparoscopic shortcomings and yields comparable results for low and high body mass index (BMI) patients. However, the impact of BMI on postoperative complications in robotic colorectal surgery remains debated. This study assessed the implications of BMI on short outcomes and postoperative complications, highlighting its unique role in the outcomes. Retrospective analysis of 119 patients who underwent robotic-assisted surgery for rectal cancer (January 2022 to March 2023). Patients grouped by BMI: normal weight (BMI < 23.9 kg/m2), overweight (BMI ≥ 23.9 kg/m2 and BMI < 27.9 kg/m2), and obese (BMI ≥ 27.9 kg/m2). Investigated BMI's impact on surgical outcomes and postoperative complications. Statistically significant differences (P < 0.05) in Clavien-Dindo, ASA scores. The obese group had a longer time to flatus (P = 0.002) and a higher re-operation rate than other groups (P = 0.01). The overweight group had a higher anastomotic fistula rate than the obese group. Overall complications showed no significant differences among BMI cohorts (P = 0.0295). There were no significant differences in TNM stages and comorbidities. BMI had no significant impact on overall postoperative complications in robotic surgery for rectal cancer. However, higher BMI correlated with a longer time to flatus and increased re-operation rate.
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Affiliation(s)
- Emilienne Fortuna Massala-Yila
- Medical College of Yangzhou University, Yangzhou, China
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
| | - Muhammad Ali
- Medical College of Yangzhou University, Yangzhou, China
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
| | - Wenhao Yu
- Medical College of Yangzhou University, Yangzhou, China
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
| | - Wei Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
| | - Jun Ren
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
| | - Daorong Wang
- Medical College of Yangzhou University, Yangzhou, China.
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China.
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Mantziari S, Thomopoulos T, Abboretti F, Gaspar-Figueiredo S, Dayer A, Demartines N, Suter M. Long-term weight loss and metabolic benefit from Roux-en-Y gastric bypass in patients with superobesity. BJS Open 2022; 6:6855490. [PMID: 36453093 PMCID: PMC9713229 DOI: 10.1093/bjsopen/zrac145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/09/2022] [Accepted: 09/29/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Although Roux-en-Y gastric bypass (RYGB) is widely performed worldwide, its efficacy in patients with a body mass index (BMI) greater than 50 kg/m2 remains controversial. The aim of the present paper was to assess long-term (10 years or more) weight loss and metabolic results of RYGB in patients with superobesity (SO; BMI > 50 kg/m2), compared with patients with morbid obesity (MO; BMI 35-50 kg/m2). METHODS This study involved retrospective analysis of a prospectively followed cohort of adult patients operated on for a primary RYGB between 1999 and 2008. Long-term weight loss and metabolic parameters were compared between SO and MO patients, with a sex-specific subgroup analysis in SO patients. Multiple logistic regression assessed independent predictors of poor long-term weight loss. RESULTS Among the 957 included patients, 193 (20.2 per cent) were SO (mean BMI 55.3 kg/m2versus 43.3 kg/m2 in MO). Upon 10-year follow-up, which was complete in 86.3 per cent of patients, BMI remained higher in SO patients (mean 39.1 kg/m2versus 30.8 kg/m2, P < 0.001) although total bodyweight loss (per cent TBWL) was similar (28.3 per cent versus 28.8 per cent, P = 0.644). Male SO patients had a trend to higher 10-year per cent TBWL, while initial BMI greater than 50 kg/m2 and low 5-year per cent TBWL were independent predictors of long-term TBWL less than 20 per cent. Diabetes remission was observed in 39 per cent SO and 40.9 per cent MO patients (P = 0.335) at 10 years, and all patients had a significant lipid profile improvement. CONCLUSION Substantial improvement in co-morbidities was observed in all patients 10 years after RYGB. Total weight loss was similar in SO and MO patients, leaving SO patients with higher BMI. Suboptimal TBWL 5 years after surgery in SO, especially female patients, may warrant prompt reassessment to improve long-term outcomes.
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Affiliation(s)
- Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland,Faculty of Biology and Medicine, University of Lausanne (UNIL),Lausanne, Switzerland
| | - Theodoros Thomopoulos
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Francesco Abboretti
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | - Anna Dayer
- Department of Surgery, Hospital of Riviera Chablais, Rennaz, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland,Faculty of Biology and Medicine, University of Lausanne (UNIL),Lausanne, Switzerland
| | - Michel Suter
- Correspondence to: Michel Suter, MD, FACS, Chief Surgeon, Hospital of Riviera Chablais, Rte des Tilles 6A, 1847 Rennaz, Switzerland (e-mail: )
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Robotic-assisted vertical sleeve gastrectomy in adolescents: Do BMI limits apply? J Pediatr Surg 2022; 57:1158-1161. [PMID: 35148900 DOI: 10.1016/j.jpedsurg.2022.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/22/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Robotic-assisted vertical sleeve gastrectomy (VSG) in adolescent patients has been shown to have comparable outcomes to laparoscopic VSG. Recent data suggests that metabolic and bariatric surgery (performed using robotic and laparoscopic techniques) in patients with BMI ≥ 50 kg/m2 have a higher risk of adverse events compared to those with BMI < 50 kg/m2. The aim of this study was to compare the outcomes of robotic-assisted VSG in adolescents with a BMI above and below 50 kg/m2. METHODS A retrospective analysis of all adolescents undergoing robotic-assisted VSG between January 2014 and December 2020. Subjects were categorized based on preoperative BMI; Group 1 (BMI < 50 kg/m2) or Group 2 (BMI ≥ 50 kg/m2). Data collection included patient demographics, preoperative BMI, total operative time, access time (i.e., total time for port-placement), 30 day complications, and 30 day hospital readmissions. Analysis was performed using chi-square, Fisher's Exact, and student t-test. RESULTS Total of 115 subjects (Group 1 N = 64 and Group 2 N = 51) were included. No differences in age or ethnicity were detected; however, Group 2 had a higher percentage of male patients (27.5% vs. 4.7%, respectively, p = 0.001). Mean operative times (Group 1 = 122.2 min vs. Group 2 = 121.6 min) and access times (Group 1 = 19.1 min vs. Group 2 = 19.7 min) were similar between groups. Thirty day complication rates were similar between groups (p = 0.133); however, there was a higher rate of hospital readmission in Group 1. CONCLUSION While recent data demonstrate an increased likelihood of adverse events occurring among patients with BMI ≥ 50 kg/m2 undergoing robotic surgery, we observed no differences in intraoperative or early postoperative outcomes based on BMI in this robotic-assisted pediatric cohort.
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Kermansaravi M, Lainas P, Shahmiri SS, Yang W, Jazi AD, Vilallonga R, Antozzi L, Parmar C, Kassir R, Chiappetta S, Zubiaga L, Vitiello A, Mahawar K, Carbajo M, Musella M, Shikora S. The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons. Surg Endosc 2022; 36:6170-6180. [PMID: 35064321 PMCID: PMC9283149 DOI: 10.1007/s00464-021-08979-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/31/2021] [Indexed: 11/27/2022]
Abstract
Background Bariatric surgery in patients with BMI over 50 kg/m2 is a challenging task. The aim of this study was to address main issues regarding perioperative management of these patients by using a worldwide survey. Methods An online 48-item questionnaire-based survey on perioperative management of patients with a BMI superior to 50 kg/m2 was ideated by 15 bariatric surgeons from 9 different countries. The questionnaire was emailed to all members of the International Federation of Surgery for Obesity (IFSO). Responses were collected and analyzed by the authors. Results 789 bariatric surgeons from 73 countries participated in the survey. Most surgeons (89.9%) believed that metabolic/bariatric surgery (MBS) on patients with BMI over 50 kg/m2 should only be performed by expert bariatric surgeons. Half of the participants (55.3%) believed that weight loss must be encouraged before surgery and 42.6% of surgeons recommended an excess weight loss of at least 10%. However, only 3.6% of surgeons recommended the insertion of an Intragastric Balloon as bridge therapy before surgery. Sleeve Gastrectomy (SG) was considered the best choice for patients younger than 18 or older than 65 years old. SG and One Anastomosis Gastric Bypass were the most common procedures for individuals between 18 and 65 years. Half of the surgeons believed that a 2-stage approach should be offered to patients with BMI > 50 kg/m2, with SG being the first step. Postoperative thromboprophylaxis was recommended for 2 and 4 weeks by 37.8% and 37.7% of participants, respectively. Conclusion This survey demonstrated worldwide variations in bariatric surgery practice regarding patients with a BMI superior to 50 kg/m2. Careful analysis of these results is useful for identifying several areas for future research and consensus building. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08979-w.
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Affiliation(s)
- Mohammad Kermansaravi
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Clamart, France
- Metropolitan Hospital of Athens, HEAL Academy, Athens, Greece
| | - Shahab Shahabi Shahmiri
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | | | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
- ELSAN, Clinique Saint Michel, Centre Chirurgical de L'Obésité, Toulon, France
| | | | - Chetan Parmar
- Department of Surgery, The Whittington Health NHS Trust, London, UK
- University College London Medical School, London, UK
| | - Radwan Kassir
- Department of Digestive Surgery, Centre Hospitalier Universitaire Félix Guyon, St Denis de la Réunion, France
| | - Sonja Chiappetta
- Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | - Lorea Zubiaga
- Miguel Hernandez of Elche University, Alicante, Spain
| | - Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Kamal Mahawar
- South Tyneside and Sunderland Foundation NHS Trust, Sunderland, UK
| | - Miguel Carbajo
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy.
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Navarrete-Arellano M. Robotic-Assisted Minimally Invasive Surgery in Children. LATEST DEVELOPMENTS IN MEDICAL ROBOTICS SYSTEMS 2021. [DOI: 10.5772/intechopen.96684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Currently, minimally invasive surgery (MIS) includes conventional laparo-thoracoscopic surgery and robot-assisted surgery (RAS) or robotic surgery. Robotic surgery is performed with robotic devices, for example the Da Vinci system from Intuitive Surgical, which has a miniaturized camera capable of image magnification, a three-dimensional image of the surgical field, and the instruments are articulated with 7 degrees of freedom of movement, and the surgeon operates in a sitting position at a surgical console near the patient. Robotic surgery has gained an enormous surge in use on adults, but it has been slowly accepted for children, although it offers important advantages in complex surgeries. The areas of application of robotic surgery in the pediatric population include urological, general surgery, thoracic, oncological, and otorhinolaryngology, the largest application has been in urological surgery. There is evidence that robotic surgery in children is safe and it is important to offer its benefits. Intraoperative complications are rare, and the frequency of postoperative complications ranges from 0–15%. Recommendations for the implementation of a pediatric robotic surgery program are included. The future will be fascinating with upcoming advancements in robotic surgical systems, the use of artificial intelligence, and digital surgery.
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Dimou FM, Ackermann N, Chang SH, Freeman D, Eagon JC, Eckhouse SR. Understanding the Current Role of Robotic-Assisted Bariatric Surgery. Obes Surg 2021; 31:3130-3137. [PMID: 33783678 DOI: 10.1007/s11695-021-05375-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/13/2021] [Accepted: 03/22/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The role of robotic surgery in bariatrics remains controversial. Patient selection for robotic surgery is not well-studied. The objective of this study was to identify factors associated with robotic surgery and its temporal trends. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database from 2015 to 2018 was used. Adult patients undergoing primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) using the laparoscopic or robotic approach were identified. Revisional, hybrid, or those with concomitant procedures were excluded. Logistic regression was conducted to identify factors associated with undergoing robotic-assisted surgery. RESULTS Among 211,568 patients who underwent SG, 9.1% underwent a robotic SG; among 76,805 patients who underwent RYGB, 7.9% of patients underwent a robotic RYGB. During 2015-2018, robotics increased from 7.1 to 11.3% for SG and 7.4 to 8.6% for RYGB. After controlling for patient characteristics, there was still an increasing trend in the use of robotic surgery: SG (multivariable-adjusted odds ratio, aOR, 1.18; 95% confidence interval, CI, 1.17-1.20) and RYGB (aOR, 1.05; 95% CI, 1.03-1.08). For both robotic SG and RYGB, functional status and African American race were associated with undergoing robotic surgery, while races other than White or African American and Hispanic ethnicity were not. Pre-operative IVC filter was associated with robotic SG, while the presence of GERD, diabetes, and COPD were associated with robotic RYGB. CONCLUSIONS Robotic bariatric surgery has increased over time. Our findings identified factors associated with the receipt of robotic surgery. Reasons for these factors require further investigation to better delineate indications for this technology.
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Affiliation(s)
- Francesca M Dimou
- Department of Surgery, Washington University in Saint Louis School of Medicine, 660 South Euclid Ave Campus Box 6109, Saint Louis, MO, 63110, USA.
| | - Nicole Ackermann
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Dawn Freeman
- Department of Surgery, Washington University in Saint Louis School of Medicine, 660 South Euclid Ave Campus Box 6109, Saint Louis, MO, 63110, USA
| | - J Christopher Eagon
- Department of Surgery, Washington University in Saint Louis School of Medicine, 660 South Euclid Ave Campus Box 6109, Saint Louis, MO, 63110, USA
| | - Shaina R Eckhouse
- Department of Surgery, Washington University in Saint Louis School of Medicine, 660 South Euclid Ave Campus Box 6109, Saint Louis, MO, 63110, USA
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Robotic Roux en Y gastric bypass can be safe and cost-effective in a rural setting: clinical outcomes from a community hospital bariatric program. J Robot Surg 2021; 15:929-936. [PMID: 33507471 DOI: 10.1007/s11701-021-01193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
Robotic Roux en Y gastric bypass (R-RYGB) is becoming more common due to the shifting trend toward robotic gastrointestinal surgery. The goal of this study is to determine if R-RYGB can be safely implemented at a robotic bariatric surgery program in a community hospital with similar results to laparoscopic RYGB (L-RYGB) in a cost-effective manner. A total of 50 R-RYGB procedures were performed with the Xi and the X da Vinci systems and compared with 50 L-RYGB cases by a single surgeon from October 2018 to January 2020 at an acute-care community hospital in a rural setting with a high-volume MBSAQIP-accredited program. A retrospective chart review was conducted with IRB approval and statistical analysis of 30-day morbidity, mortality, re-interventions, and resolution of co-morbidities, with financial analysis of cost reduction. Both groups were similar in age, gender, ASA class, co-morbidities, and body mass index (BMI). There was no mortality or anastomotic leak. The 30-day morbidity for R-RYGB was 10.0% with a re-operation rate of 4.0%. There were no conversions to open, and the mean hospital length of stay was 2.22 ± 1.19 days. There were no statistically significant differences between R-RYGB and L-RYGB with respect to any measured outcome, including intraoperative time (121.94 vs. 113.52, respectively; p = 0.1495). However, when incidences and percentages were used, R-RYGB had improved performance for most of the outcomes measuring safety. There was an average cost reduction of $816.90 per case (total saving of $40,845.00 for 50 cases) in the R-RYGB by transitioning from a hybrid approach to a totally robotic approach. R-RYGB appears to be as safe as L-RYGB and can be performed in a rural community hospital while maintaining a low complication rate, achieving a high co-morbidity resolution rate, and saving costs with a totally robotic approach.
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Abd El Aziz MA, Grass F, Perry W, Behm KT, Shawki SF, Larson DW, Mathis KL. Colectomy for patients with super obesity: current practice and surgical morbidity in the United States. Surg Obes Relat Dis 2020; 16:1764-1769. [DOI: 10.1016/j.soard.2020.06.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/08/2020] [Accepted: 06/13/2020] [Indexed: 12/30/2022]
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Pastrana M, Stoltzfus J, Claros L, El Chaar M. Outcomes of robotic bariatric surgery in super-obese patients: first report based on MBSAQIP database. Surg Obes Relat Dis 2019; 16:71-79. [PMID: 31767380 DOI: 10.1016/j.soard.2019.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/22/2019] [Accepted: 10/10/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Bariatric surgery in the super-obese (SO) patient population represents a challenge. Although the robotic platform is increasingly used for these patients, there are limited data on outcomes compared with conventional laparoscopy. OBJECTIVE Our study compared the safety and short-term outcomes of robotic and laparoscopic platforms for SO patients compared with morbidly obese patients based on the 2015 to 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. SETTING University Hospital, United States. METHODS We evaluated all primary robotic and laparoscopic cases and extracted 30-day outcomes in patients with body mass index <50 and ≤50 kg/m2. For our primary analysis, we used the Cochran-Mantel-Haenszel method with surgery type Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG) as the stratification variable to determine the association between body mass index categories and outcomes. RESULTS A total of 355,278 patients were included in our analysis. For the robotic RYGB (R-RYGB) group (n = 6645) and R-SG (n = 15,984) there were 1674 SO patients (25.2%) and 3688 SO patients (23.1%), respectively.For the laparoscopic RYGB (LRYGB) group (n = 95,374) and LSG group (n = 237,275), there were 24,991 (26.2%) and 51,524 SO patients (21.7%), respectively. The incidence of serious adverse events in SO patients for R-RYGB and LRYGB groups was 7.6% versus 7.2% (P > .05) and 4% versus 3.5% (P > .05) for R-SG and L-SG, respectively. The incidence of organ space infection in SO patients for R-RYGB and LRYGB groups was .5% versus .4% (P > .05) and .4% versus .2% (P < .05) for R-SG and LSG, respectively. CONCLUSIONS Based on 2015 to 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data, we found no difference in outcomes between robotic and laparoscopic approaches in SO patients. There was a higher incidence of serious adverse events in SO patients compared with morbidly obese patients for both approaches.
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Affiliation(s)
- Marlon Pastrana
- St Luke's University Hospital and Health Network, Lewis Katz School of Medicine at Temple University, Allentown, Pennsylvania
| | - Jill Stoltzfus
- St Luke's University Hospital and Health Network, Lewis Katz School of Medicine at Temple University, Allentown, Pennsylvania
| | - Leonardo Claros
- St Luke's University Hospital and Health Network, Lewis Katz School of Medicine at Temple University, Allentown, Pennsylvania
| | - Maher El Chaar
- St Luke's University Hospital and Health Network, Lewis Katz School of Medicine at Temple University, Allentown, Pennsylvania.
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Lundberg PW, Wolfe S, Seaone J, Stoltzfus J, Claros L, El Chaar M. Robotic gastric bypass is getting better: first results from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Surg Obes Relat Dis 2018; 14:1240-1245. [PMID: 30580769 DOI: 10.1016/j.soard.2018.05.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/30/2018] [Accepted: 05/26/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The use of robotic platforms in performing laparoscopic Roux-en-Y gastric bypass (LRYGB) is increasing, though their safety compared with the conventional laparoscopic approach remains unclear. OBJECTIVE The objective of this study was to evaluate perioperative data and 30-day outcomes of conventional and robot-assisted LRYGB using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. SETTING University health network, United States. METHODS We reviewed all conventional and robot-assisted LRYGB cases entered between January 1 and December 31, 2016 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Demographic characteristics and 30-day outcomes were analyzed based on separate Mann-Whitney rank sums tests, χ2, or Fisher's exact tests as appropriate, with P ≤ .05 denoting statistical significance with no adjustment for multiple testing. RESULTS Of the 39,425 patients who underwent LRYGB, 2822 were robot-assisted. The robot-assisted approach required significantly more time (138 versus 108 min, P < .0001). Rates of organ space infection, bleeding, and other significant adverse events after the conventional and robot-assisted approaches were .3% versus .5% (P = .13), 1.1% versus .8% (P = .11), and 2.3% versus 2.3% (P = .96), respectively. There were also no significant differences in the rates of mortality, length of stay, reoperation, or readmission between the 2 groups. CONCLUSIONS Robot-assisted LRYGB is an increasingly popular alternative to the conventional laparoscopic approach. According to the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, the early safety of these 2 techniques is equal, although the robotic approach requires more operative time.
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Affiliation(s)
| | - Samantha Wolfe
- St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Jacqueline Seaone
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jill Stoltzfus
- St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Leonardo Claros
- St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Maher El Chaar
- St. Luke's University Health Network, Bethlehem, Pennsylvania
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Gray KD, Pomp A, Dakin G, Amanat S, Turnbull ZA, Samuels J, Afaneh C. Perioperative outcomes and anesthetic considerations of robotic bariatric surgery in a propensity-matched cohort of super obese and super-super obese patients. Surg Endosc 2018; 32:4867-4873. [PMID: 29766309 DOI: 10.1007/s00464-018-6241-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/09/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND The use of the robotic platform has not been well established in patients with super obesity (SO; body mass index, BMI ≥ 50) and super-super obesity (SSO, BMI ≥ 60). We aimed to determine safety and feasibility of robotic bariatric surgery in this cohort. METHODS Review of a prospectively maintained database was performed of consecutive patients undergoing robotic bariatric surgery between 2015 and 2017. Propensity score analysis with 1:2 nearest neighbor matching was performed to control for baseline characteristics and procedure type. RESULTS A propensity-matched cohort of 47 SO patients (median BMI 55.3, range 50.1-92.5) and 94 morbidly obese (MO; median BMI 41.8, range 35.1-48.8) patients were analyzed. After matching, there were no difference in baseline characteristics including age, American Society of Anesthesiologists (ASA) score, or preoperative comorbidities. Most patients in each group underwent sleeve gastrectomy (81% of SO patients versus 76% of MO patients) or Roux-en-Y gastric bypass (13% vs. 18%, respectively), p = 0.66. There were no differences in operative time, intraoperative complications, postoperative complications, or re-admissions between groups. Length of stay was slightly longer in the MO group (2.2 days, IQR 1.8-3.2 vs. 1.8 days, IQR 1.2-2.7; p = 0.01). A subset of SSO patients (n = 11, median BMI 67, range 60-92) was analyzed; there was no increase in operation time, and zero intraoperative complications, conversions to open, or postoperative complications in this subset. CONCLUSIONS Robotic bariatric surgery can safely be performed on patients with SO or SSO with low perioperative morbidity and no increase in operating time.
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Affiliation(s)
- Katherine D Gray
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave, A1027, New York, NY, 10065, USA
| | - Alfons Pomp
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave, A1027, New York, NY, 10065, USA
| | - Gregory Dakin
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave, A1027, New York, NY, 10065, USA
| | - Sonia Amanat
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave, A1027, New York, NY, 10065, USA
| | - Zachary A Turnbull
- Department of Anesthesia, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Jon Samuels
- Department of Anesthesia, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Cheguevara Afaneh
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave, A1027, New York, NY, 10065, USA. .,Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th St, Box 294, New York, NY, 10065, USA.
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12
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Robotic Gastric Bypass Surgery in the Swiss Health Care System: Analysis of Hospital Costs and Reimbursement. Obes Surg 2017; 27:2099-2105. [DOI: 10.1007/s11695-017-2613-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Laparoscopic gastric bypass to robotic gastric bypass: time and cost commitment involved in training and transitioning an academic surgical practice. J Robot Surg 2016; 10:111-5. [DOI: 10.1007/s11701-016-0567-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 02/22/2016] [Indexed: 01/06/2023]
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14
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Bhatia P, Bindal V, Singh R, Gonzalez-Heredia R, Kalhan S, Khetan M, John S. Robot-assisted sleeve gastrectomy in morbidly obese versus super obese patients. JSLS 2016; 18:JSLS-D-14-00099. [PMID: 25392663 PMCID: PMC4208899 DOI: 10.4293/jsls.2014.00099] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background and Objectives: This study evaluates our technique for robot-assisted sleeve gastrectomy for morbidly obese and super obese patients and our outcomes. Methods: A retrospective analysis of patients who underwent robot-assisted sleeve gastrectomy at a single center was performed. The procedure was performed with the da Vinci Si HD Surgical System (Intuitive Surgical, Sunnyvale, California). The staple line was imbricated with No. 2-0 polydioxanone in all cases. The super obese (body mass index ≥50 kg/m2) subset of patients was compared with the morbidly obese group in terms of demographic characteristics, comorbidities, operative times, perioperative complications, and excess body weight loss. Results: A total of 35 patients (15 female and 20 male patients) with a mean body mass index of 48.17 ± 11.7 kg/m2 underwent robot-assisted sleeve gastrectomy. Of these patients, 11 were super obese and 24 were morbidly obese. The mean operative time was 116.3 ± 24.7 minutes, and the mean docking time was 8.9 ± 5.4 minutes. Mean blood loss was 19.36 ± 4.62 mL, and there were no complications, conversions, or perioperative deaths. When compared with the morbidly obese patients, the super obese patients showed no significant difference in operative time, blood loss, and length of hospital stay. There was a steep decline in operating room times after 10 cases of robot-assisted sleeve gastrectomy. Conclusion: This study shows the feasibility and safety of robot-assisted sleeve gastrectomy. Robotic assistance might help overcome the operative difficulties encountered in super obese patients. It shows a rapid reduction in operative times with the growing experience of the entire operative team. Robot-assisted sleeve gastrectomy can be a good procedure by which to introduce robotics in a bariatric surgery center before going on to perform Roux-en-Y gastric bypass and revision procedures.
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Affiliation(s)
- Parveen Bhatia
- Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Vivek Bindal
- Division of General, Minimally Invasive & Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Rahul Singh
- Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Raquel Gonzalez-Heredia
- Division of General, Minimally Invasive & Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Sudhir Kalhan
- Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Mukund Khetan
- Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Suviraj John
- Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
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15
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Moon RC, Gutierrez JC, Royall NA, Teixeira AF, Jawad MA. Robotic Roux-en-Y Gastric Bypass, is it Safer than Laparoscopic Bypass? Obes Surg 2015; 26:1016-20. [DOI: 10.1007/s11695-015-1884-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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16
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Lagares-Garcia J, O'Connell A, Firilas A, Robinson CC, Dumas BP, Hagen ME. The influence of body mass index on clinical short-term outcomes in robotic colorectal surgery. Int J Med Robot 2015; 12:680-685. [PMID: 26314561 DOI: 10.1002/rcs.1695] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 06/06/2015] [Accepted: 07/28/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Robotic surgery has been developed to address the technical limitations of laparoscopic surgery and might result in similar outcomes for patients with low and high body mass index (BMI). METHODS Demographic, peri-operative data and surrogate oncologic markers for colorectal cancer of patients that underwent robotic colorectal procedures were collected in a prospective database and analyzed. RESULTS 103 consecutive patients (36 normal-weight, 33 overweight, 34 obese) underwent robotic colorectal surgery from 11/2011 to 05/2012. While operating room (OR) time was longer for the obese patients (123.4 vs 137.9 and 154.7 min), results for estimated blood loss (104.2 vs 153 and 155.9 mL), conversions (2.8 vs 6.1 and 5.9%), complications (19.4 vs 21.2 and 32.4%), re-admissions (11.1 vs 112.1 and 20.6) and mortality (0% for all) were comparable. BMI did not affect the surrogate markers in patients with malignancies. CONCLUSIONS Data demonstrates that patient BMI does not have a significant impact on short-term clinical outcomes during robotic colorectal surgery. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jorge Lagares-Garcia
- Division Colon and Rectal Surgery, Roper Healthcare System, Roper Hospital, Charleston, SC, USA
| | - Abigail O'Connell
- Division Colon and Rectal Surgery, Roper Healthcare System, Roper Hospital, Charleston, SC, USA
| | - Anthony Firilas
- Division Colon and Rectal Surgery, Roper Healthcare System, Roper Hospital, Charleston, SC, USA
| | | | - Bonnie P Dumas
- Division Colon and Rectal Surgery, Roper Healthcare System, Roper Hospital, Charleston, SC, USA
| | - Monika E Hagen
- Department of Surgery, Division of Digestive Surgery, University Hospital Geneva, Geneva, Switzerland
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17
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Buchs NC, Azagury DE, Pugin F, Jung MK, Huber O, Chassot G, Morel P. Roux-en-Y gastric bypass for super obese patients: what approach? Int J Med Robot 2015; 12:276-82. [DOI: 10.1002/rcs.1660] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Nicolas C. Buchs
- Clinic for Visceral and Transplantation Surgery, Department of Surgery; University Hospital of Geneva; Switzerland
| | - Dan E. Azagury
- Clinic for Visceral and Transplantation Surgery, Department of Surgery; University Hospital of Geneva; Switzerland
| | - François Pugin
- Clinic for Visceral and Transplantation Surgery, Department of Surgery; University Hospital of Geneva; Switzerland
| | - Minoa K. Jung
- Clinic for Visceral and Transplantation Surgery, Department of Surgery; University Hospital of Geneva; Switzerland
| | - Olivier Huber
- Clinic for Visceral and Transplantation Surgery, Department of Surgery; University Hospital of Geneva; Switzerland
| | - Gilles Chassot
- Clinic for Visceral and Transplantation Surgery, Department of Surgery; University Hospital of Geneva; Switzerland
| | - Philippe Morel
- Clinic for Visceral and Transplantation Surgery, Department of Surgery; University Hospital of Geneva; Switzerland
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Abstract
OBJECTIVES The purposes of this article are to highlight what is currently known about the mechanisms of obesity-related cognitive impairment and weight loss-related cognitive improvement, and to discuss the benefits and drawbacks of available treatments. METHODS The article is based on a live debate, presenting the main advantages and disadvantages of exercise interventions and bariatric surgery as related to cognitive functioning. The live debate took place during a 1-day conference, Diabetes, Obesity and the Brain, sponsored by the American Psychosomatic Society in October 2013. RESULTS Although it is well established that bariatric surgery tends to lead to greater weight loss, better glycemic control, and cognitive improvement (effect sizes ranging between 0.61 and 0.78) during the first 1 to 2 years postintervention compared with nonsurgical treatments, medical complications are possible, and follow-up data beyond 5 years are limited. In contrast, nonsurgical therapies have been extensively studied in a variety of clinical settings and have proved that they can sustain positive health outcomes up to 10 years later, but their cognitive benefits tend to be more modest (effect sizes ranging from 0.18 to 0.69) and long-term regimen compliance, especially in obese individuals, is uncertain. CONCLUSIONS Rather than focusing on debating whether surgical or no-surgical interventions for obesity are better, additional research is needed to identify the most efficient and practical combination of approaches to ensure sustained positive health outcomes for the largest number of patients possible.
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Szold A, Bergamaschi R, Broeders I, Dankelman J, Forgione A, Langø T, Melzer A, Mintz Y, Morales-Conde S, Rhodes M, Satava R, Tang CN, Vilallonga R. European Association of Endoscopic Surgeons (EAES) consensus statement on the use of robotics in general surgery. Surg Endosc 2014; 29:253-88. [PMID: 25380708 DOI: 10.1007/s00464-014-3916-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/19/2014] [Indexed: 12/14/2022]
Abstract
Following an extensive literature search and a consensus conference with subject matter experts the following conclusions can be drawn: 1. Robotic surgery is still at its infancy, and there is a great potential in sophisticated electromechanical systems to perform complex surgical tasks when these systems evolve. 2. To date, in the vast majority of clinical settings, there is little or no advantage in using robotic systems in general surgery in terms of clinical outcome. Dedicated parameters should be addressed, and high quality research should focus on quality of care instead of routine parameters, where a clear advantage is not to be expected. 3. Preliminary data demonstrates that robotic system have a clinical benefit in performing complex procedures in confined spaces, especially in those that are located in unfavorable anatomical locations. 4. There is a severe lack of high quality data on robotic surgery, and there is a great need for rigorously controlled, unbiased clinical trials. These trials should be urged to address the cost-effectiveness issues as well. 5. Specific areas of research should include complex hepatobiliary surgery, surgery for gastric and esophageal cancer, revisional surgery in bariatric and upper GI surgery, surgery for large adrenal masses, and rectal surgery. All these fields show some potential for a true benefit of using current robotic systems. 6. Robotic surgery requires a specific set of skills, and needs to be trained using a dedicated, structured training program that addresses the specific knowledge, safety issues and skills essential to perform this type of surgery safely and with good outcomes. It is the responsibility of the corresponding professional organizations, not the industry, to define the training and credentialing of robotic basic skills and specific procedures. 7. Due to the special economic environment in which robotic surgery is currently employed special care should be taken in the decision making process when deciding on the purchase, use and training of robotic systems in general surgery. 8. Professional organizations in the sub-specialties of general surgery should review these statements and issue detailed, specialty-specific guidelines on the use of specific robotic surgery procedures in addition to outlining the advanced robotic surgery training required to safely perform such procedures.
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Affiliation(s)
- Amir Szold
- Technology Committee, EAES, Assia Medical Group, P.O. Box 58048, Tel Aviv, 61580, Israel,
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Buchs NC, Morel P, Azagury DE, Jung M, Chassot G, Huber O, Hagen ME, Pugin F. Laparoscopic Versus Robotic Roux-En-Y Gastric Bypass: Lessons and Long-Term Follow-Up Learned From a Large Prospective Monocentric Study. Obes Surg 2014; 24:2031-9. [DOI: 10.1007/s11695-014-1335-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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21
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Multifactorial analysis of the learning curve for totally robotic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 2014; 23:1753-60. [PMID: 23832519 DOI: 10.1007/s11695-013-1020-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass is one of the most commonly performed bariatric operation worldwide for the surgical management of obesity. Totally robotic Roux-en-Y gastric bypass (TR-RYGBP) has been considered to be a better approach by some groups especially early in a surgeon's experience. However, the learning curve associated with TR-RYGBP has been poorly evaluated yet. The aim of this study was to evaluate the learning curve of patients who underwent TR-RYGBP. METHODS This is a prospective study of 154 first consecutive patients undergoing TR-RYGBP to analyze the influence of surgeon experience, bedside first assistant, and patient factors on operative time and postoperative complications. To give a comprehensive view of success related to the learning process, a single hybrid variable was generated. Multivariate analysis predicted the risk factors for complications and operative time. A risk-adjusted cumulative sum analysis estimated the learning curve. RESULTS The learning curve for TR-RYGBP was 84 cases. Case rank and first assistant level were independent predictors of total operative time. Overall 30-day postoperative morbidity rate was 33.1 % and decreased over time. Surgeon experience (OR 2.6; CI 95 [1.290 to 5.479]; p = 0.0081) and first assistant level (OR 2.42; CI 95 [1.197 to 4.895]; p = 0.0139) remained independent predictors of composite event (operative time and complications). CONCLUSIONS This study identifed criteria that should be assessed in future studies about TR-RYGBP. Both surgeon experience and bedside first assistant level affected operative duration, but surgeon experience was the most significant factor in reducing complication rates.
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22
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DOMENE CE, VOLPE P, HEITOR FA. Robotic Roux-en-Y gastric bypass: operative results in 100 patients. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2014; 27 Suppl 1:9-12. [PMID: 25409957 PMCID: PMC4743510 DOI: 10.1590/s0102-6720201400s100003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/22/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic gastric bypass is gold-standard for morbid obesity treatment. AIM To describe the results of robotic gastric bypass for morbid obesity patients. METHOD Were operated on 100 morbidly obese patients through totally robotic gastric bypass between 2013 and 2014. They were 83% female. The age ranged from 20 to 65 years old (medium 48,5 years); the body mass index varied between 38-67 (medium 42,3 kg/cm2). The procedure was designed with 3 cm long gastric pouch, 1 m biliopancreatic limb, 1,2 m alimentary limb, manual or stapled anastomosis. There were four super-super-obese patients and four revisional surgeries. RESULTS Docking time varied from 1 to 20 min (medium 4 min). Console time varied from 40-185 min (medium 105 min). There were no intra operative complications or mortality. There were two lower limb deep venous thrombosis. There was no readmission in the first 30 days. CONCLUSION Totally robotic gastric bypass is safe and reproduceable, with excellent results even during the initial experience with regular surgeries, revisional surgeries or in super-obese patients. Adequate training may shortens or obviates the learning curve.
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Affiliation(s)
- Carlos Eduardo DOMENE
- From the NUTRO - Núcleo Unificado de Tratamento do Obeso (Unified Nucleus
for Treatment of the Obese), São Paulo, SP, Brazil
| | - Paula VOLPE
- From the NUTRO - Núcleo Unificado de Tratamento do Obeso (Unified Nucleus
for Treatment of the Obese), São Paulo, SP, Brazil
| | - Frederico A. HEITOR
- From the NUTRO - Núcleo Unificado de Tratamento do Obeso (Unified Nucleus
for Treatment of the Obese), São Paulo, SP, Brazil
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23
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Buchs NC, Pugin F, Azagury DE, Huber O, Chassot G, Morel P. Robotic revisional bariatric surgery: a comparative study with laparoscopic and open surgery. Int J Med Robot 2013; 10:213-7. [DOI: 10.1002/rcs.1549] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/02/2013] [Accepted: 09/24/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Nicolas C. Buchs
- Clinic for Visceral and Transplantation Surgery, Department of Surgery; University Hospital of Geneva; Switzerland
| | - François Pugin
- Clinic for Visceral and Transplantation Surgery, Department of Surgery; University Hospital of Geneva; Switzerland
| | - Dan E. Azagury
- Clinic for Visceral and Transplantation Surgery, Department of Surgery; University Hospital of Geneva; Switzerland
| | - Olivier Huber
- Clinic for Visceral and Transplantation Surgery, Department of Surgery; University Hospital of Geneva; Switzerland
| | - Gilles Chassot
- Clinic for Visceral and Transplantation Surgery, Department of Surgery; University Hospital of Geneva; Switzerland
| | - Philippe Morel
- Clinic for Visceral and Transplantation Surgery, Department of Surgery; University Hospital of Geneva; Switzerland
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