Abstract
Background
This study aimed to analyze retrospectively the authors’ preliminary experience using the Da Vinci Intuitive Robotic System for gastric bypass in managing morbid obesity, and to determine its efficacy and safety in relation to other standardized laparoscopic surgical techniques.
Methods
From October 2000 to March 2004 the authors performed 146 laparoscopic gastric bypasses, 17 of which were robot assisted using the Da Vinci Intuitive Robotic System. The last patients were 7 men and 10 women with a mean age of 44 years. The mean weight was 139 kg, and the mean body mass index (BMI) was 49.8 kg/m2 at first postoperative recovery. The mean excess body weight (EBW) was 131%. Follow-up assessment, performed at months 1, 3, 6, and 12, then yearly thereafter, included evaluation of the variations in BMI and the percentage of excess body weight loss (EBWL%). All the patients were informed of the risks inherent with each surgical procedure as well as the potential benefits.
Results
The mean operative time was 201 min (range, 90–300 min). No intraoperative complications and no conversion occurred in this series. The mean hospital stay was 9 days (range, 6–18 days). The patients in this series experienced a normal postoperative course without anastomotic complications. The mortality rate was zero. No robot-related complications were noted. The analysis of follow-up assessment at months 1, 3, 6, and 12 showed a progressive decrease in BMI and an increment of EBWL%.
Conclusions
The authors’ early experience with robotic surgery suggests that it is safe and could be an effective alternative to conventional laparoscopic surgery. The authors believe that robotic surgery, with its ability to restore the hand–eye coordination and three-dimensional view lost in laparoscopic surgery, could allow complex procedures to be performed with greater precision and better results.
Similar content being viewed by others
References
Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital Arch Surg 138: 777–784
Higa KD, Boone KB, Ho T (2000) Complications of laparoscopic Roux-en-Y gastric bypass: 1,040 patients. What have we learned? Obes Surg 10: 509–513
Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J (2000) Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232: 515–529
Wittgrove AC, Clark WG, Schubert KR (1996) Laparoscopic gastric bypass, Roux-en-Y: technique and results in 75 patients with 3–30 months follow-up. Obes Surg 6: 500–504
Gagner M, Garcia-Riuz A, Arca MJ, Heinford TB (1999) Laparoscopic isolated gastric bypass for morbid obesity. Surg. Endosc. 13: 56
NHI Consensus Development Conference Panel (1991) Gastrointestinal surgery for severe obesity. Ann Int Med 115: 956–961
Cadière GB, Himpens J (2003) Roux-en-Y gastric bypass: 191 cases. Brochure edited by Ethicon Endo-Surgery, Europe, Norderstedt (Germany)
De Maria EJ, Sugerman HJ, Kellum J, Meador JG, Wolfe LG (2002) Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 235: 640–647
Lonroth H, Dalenback J, Haglind E, Lundell L (1996) Laparoscopic gastric bypass: another option in bariatric surgery. Surg Endosc 10: 636–638
Wittgrove AC, Clark WG (2000) Laparoscopic gastric by pass, Roux-en-Y 500 patients: technique and results with 3–60 mounth follow-up. Obes Surg 10: 233–239
Van Gemert WG, van Wersch MM, Greve JWM, Soeters PB (1998) Revisional surgery after failed vertical banded gastroplasty: restoration of vertical banded gastroplasty or conversion to gastric bypass. Obes Surg 8: 21–28
Parini U, Allieta R, Millo P, Brachet Contul R, Loffredo A, Roveroni M, et al. (2002) Bypass gastrique laparoscopique pour le traitement de l’obesité morbid: indications, technique et résultats préliminaires. Le Journal de Coelio-Chirurgie 42: 30–34
Hubens G, Coveliers H, Balliu L, Ruppert M, Vaneerdewerg W (2003) A performance study comparing manual and robotically assisted laparoscopic surgery using Da Vinci system. Surg Endosc 17: 1595–1599
Hazey JW, Melvin WS (2004) Robot-assisted general surgery. Semin Laparosc Surg 11: 107–112
Cadière GB, Himpens J, Germany O, Izizaw R, Deguelohe M, Vandromme J, Capelluto E, Bruyns J (2001) Feasibility of robotic laparoscopic surgery: 146 cases. World J Surg 25: 1467–1477
MacLean LD, Rhode BM, Nohr CW (2000) Late outcome of isolated gastric bypass. Ann Surg 231: 524–528
Capella JF, Rafael F, Capella M (2002). An assessment of vertical banded gastroplasty: Roux-en-Y gastric bypass for treatment of morbid obesity. Am J Surg 183: 117–123
Pories WJ, Swanson M, Mac Donald KG (1995). Who would have thought it? An operation proves to be most effective therapy for adult-onset diabetes mellitus. Ann Surg 222: 339–352
Mouiel J (2003) Corto-circuit gastric ou gastric bypass: experience personnelle de 160 malades opérés dont 138 par laparoscopie. Le Journal de Coelio-chirurgie 46: 9–13
Nocca D, Gagner M (2003) Gastric bypass sous laparoscopie: aspects techniques et complications. Le Journal de Coelio-chirurgie 46: 32–40
Omote K, Feussner H, Ungeheurer A, Arbter K, Wei GQ, Siewert JR, Hirzinger G (1999) Self-guided robotic camera control for laparoscopic surgery compared with human camera control. Am J Surg 177: 321–324
Oliak D, Ballantyne H, Weber A, Wasilewski A, Davies RJ, Schmidt HJ (2003) Laparoscopic Roux-en-Y gastric bypass: defining the learning curve. Surg Endosc 17: 405–408
Msika S (2002) Surgical treatment of morbid obesity by gastrojejunal bypass using laparoscopic Roux-en-Y (gastric short circuit). J Chir 139: 214–217
Jones DB, Provost DA, DeMaria EJ, Smith CD, Morgenstern L, Schirmer B (2004) Optimal management of the morbidly obese patient SAGES appropriateness conference statement. Surg Endosc 18: 1029–1037
Talamini MA, Chapman S, Horgan S, Melvin WS, The Academic Robotic Group (2003) A prospective analysis of 211 robotic-assisted surgical procedures. Surg Endosc 17: 1521–1524
Gutt CN, Oniu T, Mehrabi A, Kashfi A, Schemmer P, Buchler MW (2004) Robot-assisted abdominal surgery. Br J Surg 91: 1390–1397
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Parini, U., Fabozzi, M., Brachet Contul, R. et al. Laparoscopic gastric bypass performed with the Da Vinci Intuitive Robotic System: preliminary experience. Surg Endosc 20, 1851–1857 (2006). https://doi.org/10.1007/s00464-004-9146-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-004-9146-9