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Robotic Gastric Bypass

May 28, 2014 06:59PM ● By MED Magazine

By Curtis L. Peery, MD

The rate of obesity has skyrocketed over the past three decades.  A total of $190 billion a year is spent in the United States treating disease directly correlated to obesity.  Despite this epidemic, our health care system poorly addresses the issue of obesity, and medical management has been shown to be ineffective.

The only treatment proven to resolve obesity with lasting results is bariatric surgery.  Surgery results in an average excess weight loss of 40 percent to 80 percent and significant improvement or resolution of obesity-related disease.  For example, as many as 80 percent of patients with type 2 diabetes will show resolution or improvement after a gastric bypass.  At Sanford, 90.9 percent of our patients have a reduction or resolution of at least one health problem after surgery.

Despite the proven results of gastric bypass, many patients and physicians are hesitant to pursue surgery as an option because of the small but real risk of surgical complications.  Surgeons have improved their ability to manage these complications, and the risk of death is now equivalent to that of child birth. Yet a significant concern is the rate of anastomotic leak (1 percent to 3 percent) and stenosis (3 percent to 15 percent). This morbidity cannot be ignored. These patients may have long hospitalizations and large health care bills and may miss months of work.  As surgeons we strive to make this risk as low as possible.

Robotic surgery has been performed for more than 15 years.  In many instances, it has been demonstrated to improve the outcome after surgery.  The da Vinci robotic surgical platform enables surgeons to perform complex surgery in a minimally invasive fashion similar to laparoscopic techniques.  Advantages include high-resolution 3D image, scaled movement and reticulated instruments.  This allows the surgeon to perform intuitive surgical movements similar to open surgery, which is not replicated in laparoscopic surgery.

Recent peer-reviewed studies have suggested a decrease in complications when the gastric bypass is performed robotically. In most laparoscopic gastric bypasses, the gastrojejunal anastomosis is performed in a stapled fashion.  With the robotic technique, the anastomosis is sewn rather than stapled.  This is possible due to the improved ergonomics, visualization and tremor filtration the da Vinci platform provides. These results cannot be duplicated when sewing is performed in laparoscopic cases. 

I feel this technology will decrease the number of leak and stenosis complications which occur and the number of subsequent procedures needed to deal with those complications. Every stricture results in average of one to three endoscopic dilatations, which has a leak risk of one percent to two percent.  In a study published in Obesity Surgery (Snyder et al., 2010) strictures decreased 2.2 percent to 0.9 percent when performed robotically; leaks similarly decreased from 1.7 percent to zero percent.

At Sanford Surgical Associates, I have been offering the robotic gastric bypass since November 2013.  A total of 14 robotic bypasses have been performed with no leaks or strictures.  The average length of hospital stay is 1.74 days.  My early experience has been promising, and the patients are very satisfied with the surgical experience and results. 

By providing robotic gastric bypass to our patients, we can further decrease the risk inherent to the surgery.  Over time, I am confident this will result in our ability to not only show improved safety, but also a substantial decrease in the need for hospitalization and treatment of complications. This will result in saving significant health care dollars.

Dr. Curtis Peery is a board-certified general surgeon with Sanford Surgical Associates in Sioux Falls. He has been performing robotic surgeries for 10 years.