Robotic Gastric Bypass/Duodenal Switch
Robotic-assisted laparoscopic bariatric surgery was approved in the United States in 2000. The robotic platform provides the advantages of durable instruments, stable three-dimensional optical imaging, and three robotic arms for performing the operation. In bariatric surgery, the robotic platform is particularly advantageous because it decreases mechanical strain from a thick abdominal wall and allows working in space that is limited by visceral fat. Even though the wristed instruments allow ease of hand-sewn anastomoses, the robotic arms have limited range of movement and make multi-quadrant operations challenging. Therefore, initial operative cases reported longer operative times and often incorporated a hybrid approach that used the robot for the hand-sewn anastomosis. Also, lack of haptic feedback sometimes led to iatrogenic injury and conversion to open surgery during earlier cases. Ultimately, a learning curve was defined, and operative times and outcomes have equaled or surpassed laparoscopy. Overall, the robotic-assisted Roux-en-Y gastric bypass and robotic-assisted biliary pancreatic diversion with duodenal switch are safe and valuable alternatives to laparoscopic bariatric surgery.
