Robot-assisted sleeve gastrectomy in morbidly obese versus super obese patients.
OBJECTIVE
This study evaluates our technique for robot-assisted sleeve gastrectomy for morbidly obese and super obese patients and our outcomes.


METHODS
A retrospective analysis of patients who underwent robot-assisted sleeve gastrectomy at a single center was performed. The procedure was performed with the da Vinci Si HD Surgical System (Intuitive Surgical, Sunnyvale, California). The staple line was imbricated with No. 2-0 polydioxanone in all cases. The super obese (body mass index≥50 kg/m2) subset of patients was compared with the morbidly obese group in terms of demographic characteristics, comorbidities, operative times, perioperative complications, and excess body weight loss.


RESULTS
A total of 35 patients (15 female and 20 male patients) with a mean body mass index of 48.17±11.7 kg/m2 underwent robot-assisted sleeve gastrectomy. Of these patients, 11 were super obese and 24 were morbidly obese. The mean operative time was 116.3±24.7 minutes, and the mean docking time was 8.9±5.4 minutes. Mean blood loss was 19.36±4.62 mL, and there were no complications, conversions, or perioperative deaths. When compared with the morbidly obese patients, the super obese patients showed no significant difference in operative time, blood loss, and length of hospital stay. There was a steep decline in operating room times after 10 cases of robot-assisted sleeve gastrectomy.


CONCLUSIONS
This study shows the feasibility and safety of robot-assisted sleeve gastrectomy. Robotic assistance might help overcome the operative difficulties encountered in super obese patients. It shows a rapid reduction in operative times with the growing experience of the entire operative team. Robot-assisted sleeve gastrectomy can be a good procedure by which to introduce robotics in a bariatric surgery center before going on to perform Roux-en-Y gastric bypass and revision procedures.
Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India.
Parveen
P
Bhatia
Division of General, Minimally Invasive & Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA.
Vivek
V
Bindal
Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India.
Rahul
R
Singh
Division of General, Minimally Invasive & Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA.
Raquel
R
Gonzalez-Heredia
Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India.
Sudhir
S
Kalhan
Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India.
Mukund
M
Khetan
Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India.
Suviraj
S
John
D000328:Adult; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome
Laparoscopic bariatric; Robot-assisted bariatric surgery; Robotic sleeve; Robotic surgery; Sleeve gastrectomy; Super obese