title: Totally robotic Roux-en-Y gastric bypass.
abstract: OBJECTIVE
  We hypothesized that we could develop a safe and effective technique for performing a totally robotic laparoscopic Roux-en-Y gastric bypass procedure using the da Vinci surgical system. We anticipated that the learning curve for this totally robotic procedure could be shorter than the learning curve for standard laparoscopic bariatric surgery.
  
  
  METHODS
  Retrospective case comparison study.
  
  
  METHODS
  Academic tertiary care center.
  
  
  METHODS
  Consecutive samples of patients who met National Institutes of Health (NIH) criteria for morbid obesity and who completed the Stanford Bariatric Surgery Program evaluation process.
  
  
  METHODS
  A port placement and robot positioning scheme was developed so that the entire case could be performed robotically. The first 10 patients who underwent a totally robotic laparoscopic Roux-en-Y gastric bypass were compared with a retrospective sample of 10 patients who had undergone laparoscopic Roux-en-Y gastric bypass surgery.
  
  
  METHODS
  Patient age, gender, body mass index (BMI), numbers of NIH-defined comorbidities, operative time, length of stay, and complications.
  
  
  RESULTS
  No significant differences existed between the 2 patient series with regard to age, gender, or BMI. The median surgical times were significantly lower for the robotic procedures (169 vs 208 minutes; P = .03), as was the ratio of procedure time to BMI (3.8 vs 5.0 minutes per BMI for the laparoscopic cases; P = .04).
  
  
  CONCLUSIONS
  This study details the first report, to our knowledge, of a totally robotic laparoscopic Roux-en-Y gastric bypass and demonstrates the feasibility, safety, and potential superiority of such a procedure. In addition, the learning curve may be significantly shorter with the robotic procedure. Further experience is needed to understand the long-term advantages and disadvantages of the totally robotic approach.
authors.affiliation: Department of Surgery, Stanford School of Medicine, Stanford Hospital, 300 Pasteur Drive, Stanford, CA 94305, USA.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Mohr
authors.forename: Geoffrey S
authors.initials: GS
authors.lastname: Nadzam
authors.forename: Myriam J
authors.initials: MJ
authors.lastname: Curet
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D010149:Postoperative Pain / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012371:Robotics; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015431:Weight Loss