Obesity Surgery

, Volume 29, Issue 2, pp 721–728 | Cite as

Stapler-Less Robotic Partial Gastrectomy: a Safety and Feasibility Experimental Study

  • Tomasz RogulaEmail author
  • David Leifer
  • Jacob A. Petrosky
  • Xiuli Liu
  • Michal Janik
  • Valerie Zeer
  • Piotr Fiedorczuk
  • Jan Baczek
  • Philip Schauer
New Concept



No true preliminary work has been performed and published on the use of the bipolar cautery devices for transection of the stomach when performed as a part of the sleeve gastrectomy or gastric wedge resection. The objective of this study was to investigate the feasibility and safety of substitution of linear surgical stapling devices for use of a bipolar electrosurgical sealing instrument in the performance of a totally robotic partial gastrectomy (TRPG).


Ten female pigs were assigned to an intervention or control group. Intervention included TRPG with a robotic bipolar tissue coagulation device. In the control group, TRPG was performed using the staplers. Assessed outcomes included presence of the intraoperative and postoperative bleeding or leak and features of the sections from the stapled line or sutured line.


Mean operating time was (130 ± 31 min) and (87 ± 23 min) in the study and control groups (p = 0.03). Intraoperative gastroscopy revealed slow bleeding associated with the staple line in 3/5 control pigs; oozing was not appreciated in any of the study pigs (0/5). No leak was detected during intraoperative gastroscopy. No major complications were suspected postoperatively or identified at postmortem exam in either group. Mean injury width was (1.12 ± 0.93 mm) in the control group with greater mean injury width (7.88 ± 3.73 mm) in the study group (p = 0.001). Mean depth of ulceration was (0.99 ± 0.94 mm) in the control group, with greater mean ulceration depth (2.25 ± 0.84 mm) in the study group (p = 0.002).


The study showed the technical feasibility of performing stapler-less gastric wedge resection. The electrocautery alone failed to demonstrate the technical feasibility which was obtained with the concomitant use of a tissue clamp and a suture.


Stapler-less totally robotic sleeve gastrectomy Partial gastrectomy Wedge gastric resection Animal model Experimental surgery 



Affordable Care Act


Accountable Care Organization


American Society of Metabolic and Bariatric Surgeons


Confidence interval


Laboratory animal research


Laparoscopic Roux-en-Y gastric bypass


Laparoscopic sleeve gastrectomy


Roux-en-Y gastric bypass


Totally robotic sleeve gastrectomy


US dollar


Compliance with Ethical Standards

Ethical Approval Statement

All applicable institutional and/or national guidelines for the care and use of animals were followed. The Cleveland Clinic’s Institutional Animal Care and Use Committee approved the study protocol (2015-1377).

Informed Consent Statement

Does not apply.


The study was supported by Intuitive Surgical, Sunnyvale, CA, USA (2015 Clinical Robotic Research Grant) to help offset the costs associated with acquisition and perioperative care of the animals.

The study was carried out at the Cleveland Clinic Animal Facility which is fully accredited by AAALAC International.

Conflict of Interest

Tomasz Rogula reports grants and non-financial support from Intuitive Surgical, during the conduct of the study.

David Leifer has nothing to disclose.

Jacob A. Petrosky has nothing to disclose.

Xiuli Liu has nothing to disclose.

Michal Janik has nothing to disclose.

Valerie Zeer has nothing to disclose.

Piotr Fiedorczuk has nothing to disclose.

Jan Baczek has nothing to disclose.

Philip Schauer has nothing to disclose.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Case Western Reserve UniversitySchool of MedicineClevelandUSA
  2. 2.Faculty of Medicine and Health SciencesJan Kochanowski UniversityKielcePoland
  3. 3.Cleveland ClinicClevelandUSA
  4. 4.University of FloridaGainesvilleUSA
  5. 5.Department of General, Oncologic, Metabolic and Thoracic SurgeryMilitary Institute of Medicine WarszawaWarsawPoland
  6. 6.Medical University of BialystokBiałystokPoland

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