title: Robotically assisted biliary pancreatic diversion with a duodenal switch: a new technique.
abstract: BACKGROUND
  Minimally invasive surgical techniques decrease the length of hospitalization and the morbidity for general surgery procedures. Application of minimally invasive techniques to obesity surgery had previously been limited to stapled techniques used primarily for the Roux-en-Y gastric bypass and laparoscopic band placement. The authors present the technique for totally intracorporeal robotically assisted biliary pancreatic diversion with a duodenal switch (BPD/DS) using five ports.
  
  
  METHODS
  After development of the technique in animal and human cadaver models, the da Vinci robot was first used in October 2000 to perform BPD/DS using five ports and a totally intracorporeal technique. Patient selection was based on standard surgery guidelines for the morbidly obese.
  
  
  RESULTS
  This technique was applied for 47 patients with a mean body mass index (BMI) of 45 kg/m2 and a mean age of 38 +/- 10 years. The median operating time was 514 min (range, 370-931 min). The median operative time for the last 10 patients was 379 min (range, 370-582 min). Three patients underwent conversion to open surgery, and four patients experienced postoperative leaks with no mortality.
  
  
  CONCLUSIONS
  The safety, feasibility, and reproducibility of a minimally invasive robotic surgical approach to complex abdominal operations such as BPD/DS is demonstrated. The BPD/DS allows for a sutured bowel anastomosis similar to the open technique using a minimal number of small access ports.
authors.affiliation: Department of Surgery, Creighton University Medical Center, 601 N, 30th Street, Omaha, NE 68131, USA. ranjansudan@creighton.edu
authors.forename: R
authors.initials: R
authors.lastname: Sudan
authors.forename: V
authors.initials: V
authors.lastname: Puri
authors.forename: D
authors.initials: D
authors.lastname: Sudan
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion / Q000009:adverse effects / Q000379:methods*; D004386:Duodenum / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000628:therapy; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome