How I Do It: Robotic Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADIS)
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HOW I DO IT
How I Do It: Robotic Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADIS) Christine Tat, MD 1 FASMBS 1,4
&
Gabriel Diaz del Gobbo, MD 1 & Michael Klingler, MD 2,3 & Ricard Corcelles, MD, PhD, FACS,
Received: 13 July 2020 / Accepted: 3 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Introduction Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADIS) is a type of bariatric surgery that has recently gained endorsement from major bariatric surgery societies. It is currently endorsed by both International Federation for the Surgery of Obesity and Metabolic Surgery (IFSO) and American Society for Metabolic and Bariatric Surgery (ASMBS). 1,2 Meanwhile, robotic surgery with the da Vinci® Surgical System by Intuitive has gained popularity in recent years. At our institution, we have used both the Si and Xi da Vinci® robotic surgical platforms for SADIS. The steps for robotic SADIS is described in the next section and accompanied by a video.
Pre-Operative Evaluation Patients undergo the routine bariatric pathway. At our institution, it consists of pre-operative evaluation with surgery, internal medicine, psychiatry, and dieticians. Revisional cases Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11605-020-04789-y) contains supplementary material, which is available to authorized users. * Ricard Corcelles, MD, PhD, FACS, FASMBS [email protected] 1
Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
2
Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
3
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
4
Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Cleveland Clinic Lerner College of Medicine, PO Box: 112412, Abu Dhabi, United Arab Emirates
also include a pre-operative upper gastrointestinal series and EGD.
Operation The peritoneal cavity can be initially accessed via numerous techniques. Our preference is to use the Veress needle. On the Si platform, the 5 trocars span across the mid-abdomen in a gentle U-shape at the level of the umbilicus (Fig. 1). The first trocar to be placed is the 12-mm laparoscopic port at the periumbilical position and used for the camera. Then, an 8-mm robotic trocar is placed at the right anterior axillary line. An 8mm robotic port is placed at the right mid-clavicular line. An 8-mm robotic port is placed in the left mid-clavicular line. The last trocar is a 12-mm laparoscopic port placed at the left midaxillary line. This will be used by the bedside assistant. On the Xi platform, 5 trocars are placed in a relatively straight line along the mid-abdomen at the level of the umbilicus (Fig. 2). The first trocar introduced is an 8-mm robotic port at the peri-umbilical position for the camera. An 8-mm robotic trocar is placed at the right anterior axillary line. An 11-mm robotic trocar is placed at the right mid-clavicular line. An 8-mm robotic
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