Comparison of totally robotic laparoscopic Roux-en-Y gastric bypass and traditional laparoscopic Roux-en-Y gastric bypass.
BACKGROUND
Laparoscopic gastric bypass is a technically demanding operation, especially when hand-sewing is required. Robotics may help facilitate the performance of this difficult operation. This study was undertaken to compare a single surgeon's results using the daVinci Surgical System with those using traditional laparoscopic Roux-en-Y gastric bypass (LRYGB) when the techniques were learned simultaneously.


METHODS
From July 2004 to April 2005, the new laparoscopic fellow's first 50 patients were randomized to undergo either LRYGB or totally robotic laparoscopic Roux-en-Y gastric bypass (TRRYGB). Data were collected on patient age, gender, body mass index (BMI), co-morbidities, operative time, complication rates, and length of stay. Student's t test with unequal variances was used for statistical analysis.


RESULTS
No significant differences in age, gender, co-morbidities, complication rates, or length of stay were found between the two groups. The mean operating time was significantly shorter for TRRYGB than for LRYGB (130.8 versus 149.4 minutes; P = 0.02), with a significant difference in minutes per BMI (2.94 versus 3.47 min/BMI; P = 0.02). The largest difference was in patients with a BMI >43 kg/m(2), for whom the difference in procedure time was 29.6 minutes (123.5 minutes for TRRYGB versus 153.2 minutes for LRYGB; P = 0.009) and a significant difference in minutes per BMI (2.49 versus 3.24 min/BMI; P = 0.009).


CONCLUSIONS
Our data indicate that the use of the daVinci Surgical System for TRRYGB is safe and feasible. The operating room time is shorter with the use of the robotic system during a surgeon's learning curve, and that decrease is maximized in patients with a larger BMI. TRRYGB may be a better approach to gastric bypass when hand-sewing is required, especially early in a surgeon's experience.
Sanchez
Barry R
BR
Department of Surgery, Stanford University Medical Center, Stanford, California 94305, USA.
Mohr
Catherine J
CJ
Morton
John M
JM
Safadi
Bassem Y
BY
Alami
Ramzi S
RS
Curet
Myriam J
MJ
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D002983:Clinical Competence; D005260:Female; D015390:Gastric Bypass / Q000193:education / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D012371:Robotics / Q000191:economics / Q000193:education; D016896:Treatment Outcome