BACKGROUND: Traditional laparoscopic surgery presents some difficulties for morbidly obese patients due to limited motion of instruments related to a thick abdominal wall, intraabdominal fat, and a large hepatic left lobe, with consequent loss of dexterity and greater musculoskeletal discomfort. Robotic technique could potentially overcome these limitations. This study aimed to evaluate robot-assisted laparoscopic Roux-en-Y gastric bypass in morbidly obese patients and to compare the results of robotic assistance with those of traditional laparoscopic technique. METHODS: Between September 2006 and June 2009, 110 morbidly obese patients underwent laparoscopic Roux-en-Y gastric bypass with robot-assisted hand-sewn gastrojejunal anastomosis using the da Vinci Surgical System. The data for these patients was compared with the data for 423 consecutive patients treated in a standard laparoscopic manner during the same period. RESULTS: The patients had a mean preoperative age of 42.6 years, a mean weight of 127.5 kg, and a mean body mass index (BMI) of 46.7 kg/m2. The total mean operative time was 247.5 min. The robotic setup time was 10.1 min, and the robotic operative time was 54.5 min. The conversion rate was nil. The intraoperative complication rate was 4.5%. The early and late major postoperative complication rates were 3.6 and 6.4% respectively. The cost per patient was 5777.76 €. For the standard laparoscopy, the operative time was significantly shorter (187 min; p<0.001), and the costs per patient were significantly lower (4658.28 €; p<0.001), whereas no differences were found in terms of the intra- or postoperative complication rates, revisional surgery, or hospital length of stay. CONCLUSIONS: Although safe and intuitive, the robotic approach was burdened by a longer operative time and higher equipment costs. Moreover, it did not seem to provide a real advantage over standard laparoscopy in terms of hospital length of stay and complications rates.
BACKGROUND: Traditional laparoscopic surgery presents some difficulties for morbidly obesepatients due to limited motion of instruments related to a thick abdominal wall, intraabdominal fat, and a large hepatic left lobe, with consequent loss of dexterity and greater musculoskeletal discomfort. Robotic technique could potentially overcome these limitations. This study aimed to evaluate robot-assisted laparoscopic Roux-en-Y gastric bypass in morbidly obesepatients and to compare the results of robotic assistance with those of traditional laparoscopic technique. METHODS: Between September 2006 and June 2009, 110 morbidly obesepatients underwent laparoscopic Roux-en-Y gastric bypass with robot-assisted hand-sewn gastrojejunal anastomosis using the da Vinci Surgical System. The data for these patients was compared with the data for 423 consecutive patients treated in a standard laparoscopic manner during the same period. RESULTS: The patients had a mean preoperative age of 42.6 years, a mean weight of 127.5 kg, and a mean body mass index (BMI) of 46.7 kg/m2. The total mean operative time was 247.5 min. The robotic setup time was 10.1 min, and the robotic operative time was 54.5 min. The conversion rate was nil. The intraoperative complication rate was 4.5%. The early and late major postoperative complication rates were 3.6 and 6.4% respectively. The cost per patient was 5777.76 €. For the standard laparoscopy, the operative time was significantly shorter (187 min; p<0.001), and the costs per patient were significantly lower (4658.28 €; p<0.001), whereas no differences were found in terms of the intra- or postoperative complication rates, revisional surgery, or hospital length of stay. CONCLUSIONS: Although safe and intuitive, the robotic approach was burdened by a longer operative time and higher equipment costs. Moreover, it did not seem to provide a real advantage over standard laparoscopy in terms of hospital length of stay and complications rates.
Authors: Lars Sjöström; Anna-Karin Lindroos; Markku Peltonen; Jarl Torgerson; Claude Bouchard; Björn Carlsson; Sven Dahlgren; Bo Larsson; Kristina Narbro; Carl David Sjöström; Marianne Sullivan; Hans Wedel Journal: N Engl J Med Date: 2004-12-23 Impact factor: 91.245
Authors: Ninh T Nguyen; Marcelo Hinojosa; Christine Fayad; Esteban Varela; Samuel E Wilson Journal: J Am Coll Surg Date: 2007-06-27 Impact factor: 6.113
Authors: Christopher G Andrew; Wael Hanna; Didier Look; Alexander P H McLean; Nicolas V Christou Journal: Can J Surg Date: 2006-12 Impact factor: 2.089
Authors: Hong Man Yoon; Young-Woo Kim; Jun Ho Lee; Keun Won Ryu; Bang Wool Eom; Ji Yeon Park; Il Ju Choi; Chan Gyoo Kim; Jong Yeul Lee; Soo Jeong Cho; Ji Yoon Rho Journal: Surg Endosc Date: 2011-11-16 Impact factor: 4.584
Authors: Blair A Wormer; Kristian T Dacey; Kristopher B Williams; Joel F Bradley; Amanda L Walters; Vedra A Augenstein; Dimitrios Stefanidis; B Todd Heniford Journal: Surg Endosc Date: 2013-11-07 Impact factor: 4.584
Authors: Ismael Diez Del Val; Cándido Martinez Blazquez; Carlos Loureiro Gonzalez; Jose Maria Vitores Lopez; Valentin Sierra Esteban; Julen Barrenetxea Asua; Izaskun Del Hoyo Aretxabala; Patricia Perez de Villarreal; Jose Esteban Bilbao Axpe; Jaime Jesus Mendez Martin Journal: J Robot Surg Date: 2013-09-14