Robotic laparoscopic Roux-en-Y gastric bypass surgery

A system that allows surgeons to perform laparoscopic gastric bypass surgery from a remote console, controlling up to three robotic arms and a binocular camera, was successfully tested in 10 patients, according to a study in the August issue of Archives of Surgery.

The laparoscopic gastric bypass surgery (a Roux-en-Y procedure) is often considered the most challenging minimally invasive procedure in general surgery, requiring a learning curve of 75 to100 cases for even experienced surgeons to achieve the highest level of proficiency, according to background information in the article. Although robotic surgical techniques have been developed to assist laparoscopic gastric bypass surgery, the complex geometry of the surgery has required repositioning of the robot, complicating its use.

Catherine J. Mohr, M.S.M.E., of the Stanford School of Medicine, Calif., and colleagues report the first 10 patients to undergo a totally robotic laparoscopic Roux-en-Y gastric bypass surgery (during March and April 2004) using a technique developed to minimize robot repositioning. The results were compared with a sample of 10 patients who had undergone standard laparoscopic Roux-en-Y gastric bypass surgery during July to September 2002. There were no significant differences in the general health, age or body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) of the two sets of patients. All patients were women. The researchers compared surgical times as well as the ratio of the procedure time to the patient's BMI.

The number and severity of complication were comparable, the researchers found. "The median length of time to complete the procedure was significantly shorter with the robot (169 vs. 208 minutes)," the authors report. "In addition, the ratio of procedure time to BMI was considerably lower with the robot (median, 3.8 vs. 5.0 minutes per BMI for the laparoscopic cases). Moreover, the rate at which the operative times improved indicate that the learning curve for the robotic procedure is considerably shorter. We found that the mean minutes per BMI of our second five robotic procedures was 3.45 minutes, whereas the laparoscopic data for our senior attending surgeon did not attain a comparable five-case mean of the metric until case 42. In addition, when the data from a bariatric fellow from the same institution [Stanford Medical School] were compared, that surgeon did not match the metric until surgical case 85."

"Reluctance to use new technology such as the … surgical robot often reflects surgeon concern over increasing complication rates, increased operative times, and steep learning curves," the authors conclude. "Any new technology must be proven feasible and safe. Our results support the robot's feasibility in the Roux-en-Y gastric bypass as we achieved comparable operating room times with an extremely short learning curve. … Likewise, both major and minor complications were similar between the robotic and laparoscopic group, suggesting that a totally robotic laparoscopic gastric bypass is a safe and potentially superior alternative to traditional laparoscopic gastric bypass."

http://archsurg.ama-assn.org/