Robot-Assisted Roux-en-Y Gastric Bypass for Super Obese Patients: A Comparative Study
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CLINICAL REPORT
Robot-Assisted Roux-en-Y Gastric Bypass for Super Obese Patients: A Comparative Study Nicolas C. Buchs & François Pugin & Gilles Chassot & Francesco Volonte & Pascale Koutny-Fong & Monika E. Hagen & Philippe Morel
Published online: 27 November 2012 # Springer Science+Business Media New York 2012
Abstract Superobese patients (SO) (body mass index (BMI)≥50 kg/m2) represent a real surgical challenge and the best management remains debatable. While the safety of a laparoscopic approach has been questioned for this population, robotics has been introduced in the armamentarium of the bariatric surgeon, yet its role remains poorly assessed, especially for a very high BMI. The study aim is thus to report our experience with robot-assisted Roux-en-Y gastric bypass (RYGB) for SO. From July 2006 to May 2012, 288 consecutive robot-assisted RYGB procedures have been performed at a single institution. All data were collected prospectively in a dedicated database. Among those patients, 41 were SO (14.2 %). All the peri- and postoperative parameters were compared to the morbidly obese (MO) group (BMI60. Even if we extrapolate these data to our SO population, we cannot confirm these results because fortunately we had no leak so far. There is no real consensus concerning the choice of the procedure for SO. Globally, in critically morbid patients, a sleeve gastrectomy can be considered as a first step in a twostage procedure [7] or can even be considered more and more often as a single-stage procedure [29]. The outcomes reported so far are encouraging, but only few data are available for the long-term follow-up [30]. In a two-stage procedure, a duodenal switch (or a RYGB) is usually proposed, requiring advanced laparoscopic skills. The development of robotics was seen as a real technological help in performing anastomosis
OBES SURG (2013) 23:353–357
and complex dissection or reconstruction [31–33]. For bariatric surgery, the introduction of robotic technology has slowly gained an increased interest, notably by obtaining better outcomes. Very recently, the largest series of robot-assisted RYGB reported a leak rate of 0.09 % [34]. In fact, this dualcenter study reported only one leak after 1,100 procedures [34]. The gastrojejunal leak rate after laparoscopic RYGB is classically higher with a range reported to be between 1 and 4 % [11, 14]. Several comparative series have clearly shown a reduced anastomotic complication rate after RYGB [14, 15, 35]. Finally, in a systematic review, Markar and colleagues [35] found a reduced incidence of anastomotic stricture with the robotic approach when compared to laparoscopy. However, robotic technology is often criticized for the longer operative time associated to its use, even if this difference did not reach a statistical significance in a recent systematic review [35]. In the present series, contrary to other laparoscopic series [11], we have shown that there was no difference in terms of operative time between both groups of patients, yet it can be considered longer than pre
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