Clinical Challenges in Robotic Bariatric Surgery: The Robot is Here to Stay!
Episode 4
Join us as we dissect the use of robotics in bariatric surgery – where precision meets programming, and the scalpel gets a software upgrade.
Video Clip Link:
https://app.behindtheknife.org/video/clinical-challenges-in-robotic-bariatric-surgery-the-robot-is-here-to-stay
This videos includes:
- Robotic RYGB
- Robotic Sleeve Gastrectomy
- SADI: Single Anastomosis Duodenoileostomy
Hosts:
- Matthew Martin, trauma and bariatric surgeon at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California)
- Adrian Dan, bariatric and MIS surgeon, program director for the advanced MIS bariatric and foregut fellowship at Summa Health System (Akron, Ohio)
- Crystal Johnson Mann, bariatric and foregut surgeon at the University of Florida (Gainesville, Florida)
- Katherine Cironi, general surgery resident at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California)
Learning objectives:
- Strengths of the robot:
- Surgical robots are at the forefront of technology and continue to improve with detailed, precision cameras and the ability to remove baseline tremors
- Allows for smooth movements, fine dissection, and precise tissue handling
- Ergonomics are more advantageous to the surgeon when compared to laparoscopy
- Weaknesses of the robot:
- The loss of haptic feedback can be challenging for surgeons early in their learning curve
- Emphasis on surgical robots means some trainees may be losing exposure to laparoscopic techniques
- Longer operative time when working robotically, and more time under anesthesia for the patient
- Increased cost for robotic surgery
- Outcomes data:
- Mixed data from the MBSA QIP database (metabolic and bariatric surgery accreditation and quality improvement program)
- The most recent study looked at 824,000 patients from 2015-2022 who had a sleeve gastrectomy or RNY gastric bypass, either laparoscopically (lap sleeve 61%, lap RYGB 24%) or robotically (robo sleeve 11%, robo RYGB 4%).
- Robotic sleeves were reported to have higher complication rates compared to laparoscopy, seen as higher overall morbidity and an increased rate of leaks
- While the robotic RYGBs have lower overall complications, including decreased morbidity and bleeding. Robotic RYGB can be especially advantageous with revisional surgeries when compared to lap.
- Setting up for success
- Train your eyes to determine tension on tissue, since there is no haptic feedback
- Learn how to assist yourself (manipulating the camera and effectively utilizing the fourth arm)
- Understand how techniques of the surgery change when doing it robotically, as compared to laparoscopy
- Experienced operating room team
- When learning, recommend putting all cases feasible on the robot (including easier cases), to master the straightforward cases before moving to technically challenging revision cases.
- Don’t hesitate to add an additional trocar or assistant port when needed
- Education in Robotic learning
- Learning by observation/mirroring – ex: robotic bilateral inguinal hernia (mirroring the attending/instructor)
- Easy for the attending/instructor in the case to switch instruments seamlessly, then give them back intermittently at the appropriate time
- Helpful when the attending annotates the screen to depict where to go
- Data-driven teaching tools on the Davinci system
- Tips for robotic sleeve gastrectomy: