title: Early Australian experience in robotic sleeve gastrectomy: a single site series.
abstract: BACKGROUND
  The use of robotic platforms in bariatric surgery has recently gained relevance. With an increased use of this technology come concerns regarding learning curve effects during the initial implementation phase. The sleeve gastrectomy though may represent an ideal training procedure for introducing the robot into bariatric surgical practice. The present review of the first 10 consecutive robotic sleeve gastrectomy procedures performed in an Australian bariatric programme by a single surgeon describes the evolution of the technique, learning curve and initial patient outcomes.
  
  
  METHODS
  Between 2014 and 2015, robotic sleeve gastrectomies were performed as primary and revisional procedures by a consistent surgeon-assistant team. Technique evolution and theatre set-up were documented. Patient demographics, operative time (robot docking and total operation time), additional operative procedures performed, operative and post-operative complications at 1, 3 and 6 months post-procedure and weight loss achieved at 6 months were retrospectively reviewed from a prospectively maintained database.
  
  
  RESULTS
  Ten robotic sleeve gastrectomies were performed without significant operative complications. One patient was treated as an outpatient with oral antibiotics for a superficial wound infection. The median total operative time was 123 min (interquartile range (IQR) 108.8-142.5), with a median incision to docking time of 19 min (IQR 15.0-31.8). Length of stay in hospital was 2-3 days. Median excess weight loss achieved at 6 months was 50% (IQR 33.9-66.5).
  
  
  CONCLUSIONS
  This study describes a method of safely introducing the da Vinci robot into bariatric surgical practice.
authors.affiliation: Department of General Surgery, John Flynn Private Hospital, Gold Coast, Queensland, Australia.
authors.forename: Candice D
authors.initials: CD
authors.lastname: Silverman
authors.affiliation: Department of General Surgery, John Flynn Private Hospital, Gold Coast, Queensland, Australia.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Ghusn
mesh_terms: D001315:Australia / Q000453:epidemiology; D050110:Bariatric Surgery / Q000379:methods; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000193:education / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000193:education / Q000295:instrumentation* / Q000379:methods; D012371:Robotics / Q000295:instrumentation*; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology
keywords: bariatric surgery; learning curve; robotic sleeve gastrectomy; robotic surgery; sleeve gastrectomy