Does Robotic Surgery Improve Outcomes for Bariatric Patients?

What is the benefit of utilizing advanced robotic technology such as the da Vinci® Robotic Surgical System, a robot for performing bariatric surgery? This is a typical question that many minimally invasive bariatric surgeons are being asked in this day and age. The answer to this question comes down to “precision,” but you may benefit from some additional explanation.

A Brief History of Robotic Surgery

davinci_surgical_systemA brief lesson about the history of robotic surgery would be very useful in helping to answer that question. In the early 1990’s the Defense Advanced Research Projects Agency (DARPA), an advanced, technological agency of the U.S. Department of Defense decided to fund a project designed to allow injured soldiers to have necessary surgical interventions performed while they were still in the battle field. They determined that a robot could permit a surgeon to operate on the injured soldier at a distance. Such was the start of the modern surgical robotic revolution.

In 1999, a group from Belgium first used robotic technology for bariatric surgery to implant a Laparoscopic Band device. Over the following decade, robotic technology became a prominent feature in urological surgery, more specifically the removal of the prostate. In 2009, gynecological surgeons began utilizing robotic technology on procedures such as hysterectomy.

Robotics in Bariatric Surgery

da Vinci.procedure 2It wasn’t until 2011 that the bariatric surgical community began to look at the robotic technology more seriously. By this time, robotic technology had matured enough to allow advanced laparoscopic surgeons to perform complex surgeries that were not previously possible – even using robotic technology. A less glamorous explanation is that there was more marketing by both the hospitals and the robotic manufacturer. While the exact explanation for the use of robotic technology in bariatric surgery is difficult to confirm, suffice it to say that the robotic technology is here to stay.

As of this writing in early 2015, most of the bariatric programs in the Philadelphia area and Delaware are beginning to offer the robotic technology in bariatric surgery. In 2013, I initiated a robotic surgery program for the Center for Minimally Invasive and Bariatric surgery at Crozer-Chester Medical Center. To date we have performed around 250 major robotic procedures using the da Vinci, including more than 230 bariatric procedures.

The robotic platform allows the surgeons to operate on the more complex patients including those that weigh more than 300 pounds or have a body mass index (BMI) more than 50. The robot is able to provide the necessary strength to help negotiate the heavier abdominal wall that is usually seen in people with a BMI greater than 50. Greater accuracy improves the chance that the surgery will have a safe outcome.

The Advantage of Robotics in Revisional Bariatric Surgery

da vinci 2The major benefit of the robotic technology is that it allows for a more precise surgical platform for performing revisional bariatric surgery. As the number of bariatric surgery patients has surpassed a few million in the United States, the number of patients requiring revisional or conversional bariatric surgery has greatly increased.

The 3-D visual technology offered by the da Vinci robotic surgery platform provides a very stable and superior image that is crucial for performing such a complex, minimally invasive procedure. In addition, the surgeon is able to perform the surgery in a far more comfortable and ergonomic manner, thus allowing the operating surgeon to concentrate more energy on the surgery and less on the discomfort associated with traditional open or laparoscopic surgery.

The key to a successful robotic program is to have properly trained robotic bariatric surgeons who use this technology on a routine basis and thus become very proficient at providing the necessary safe technique that is required to have excellent outcomes.

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