DaVinci robotic-assisted laparoscopic bariatric surgery: is it justified in a routine setting?
BACKGROUND
Laparoscopic silicone adjustable gastric banding (SAGB) has gained popularity for the surgical treatment of morbid obesity. The implantable gastric stimulator (IGS) system represents a novel surgical alternative. We aimed to assess the feasibility of robotic-assisted laparoscopic bariatric operations and to critically elucidate the technical and financial advantages and patient outcome.


METHODS
Robotic-assisted laparoscopic bariatric procedures were performed on 10 consecutive patients using the daVinci robot system (4 SAGB, 4 IGS, 2 SAGB revisions). 10 conventional laparoscopic-operated patients (4 SAGB, 4 IGS, 2 SAGB revisions) during the learning curve served as controls. Equipment, operative technique and procedural time were evaluated. A cost analysis was calculated.


RESULTS
The personnel equipment, numbers of trocars and operation technique were comparable in both groups. The mean operative time was 137 min (range 110-175) and 97 min (60-140) in robotic-assisted and conventional laparoscopy, respectively (P =0.04). Establishment of the pneumoperitoneum and placement of trocars and robotic arms took a mean of 30 min (15-45) in the robotic-assisted group, compared with 5 min in the control group (P <0.001). In 1 patient, intraoperative gastric injury was suspected and led to band removal in the robotic-assisted group. There was no postoperative complication. Average procedural costs were significantly higher in the robotic-assisted group.


CONCLUSIONS
Primary and revisional robotic-assisted bariatric surgery is technically simple, with the benefit of precise instrument handling. However, it is still expensive, the set-up of the system is time-consuming, and a limited variety of instruments are available presently.
Mühlmann
Gilbert
G
Department of General and Transplant Surgery, University Hospital Innsbruck, Austria.
Klaus
Alexander
A
Kirchmayr
Werner
W
Wykypiel
Heinz
H
Unger
Andreas
A
Höller
Elisabeth
E
Nehoda
Hermann
H
Aigner
Franz
F
Weiss
Helmut G
HG
D000293:Adolescent; D000328:Adult; D003365:Costs and Cost Analysis; D005240:Feasibility Studies; D005260:Female; D015391:Gastroplasty / Q000191:economics / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D012086:Reoperation; D012371:Robotics / Q000191:economics / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome