Robot-Assisted Laparoscopic Roux-en-Y Gastric Bypass Technique

Abstract

Introduction:

Roux-en-Y gastric bypass is the second most commonly performed bariatric operation in the United States. ¹ Over the past decade, the utilization of the robotic platform has increased primarily due to its advantages of improved observation, ergonomics, dexterity, and shorter learning curve especially in complex operations such as Roux-en-Y gastric bypass. ^{2 –4} At our institution, we adopted the robotic approach in performing Roux-en-Y gastric bypass with good outcomes. We are presenting this case to describe our technique in performing this operation.

Materials and Methods:

A 26-year-old woman presented to our clinic with a body mass index of 47.5 kg/m² (weight 146.1 kg and height 175.3 cm). Obesity-related comorbidities included obstructive sleep apnea and gastroesophageal reflux disease. After appropriate preoperative evaluation, she was found to be a good candidate for a robot-assisted laparoscopic Roux-en-Y gastric bypass using the Da Vinci Xi surgical system. The abdomen was accessed and insufflated using a Veress needle placed at Palmer's point. Four robotic trocars were placed in a straight line across the abdomen 15 cm inferior to the xiphoid. An 8 mm assistant port was placed in the right upper quadrant.

A Nathanson liver retractor placed subxiphoid was used to elevate the left lobe of the liver. The transverse colon was elevated and the ligament of Treitz was identified. The biliopancreatic limb was marked 125 cm distal to the ligament of Treitz. After the omentum was divided, the gastric pouch was created using a series of 60 mm SureForm™ stapler with green loads. The marked bowel loop was brought up in an ante-colic ante-gastric manner through the split omentum. A two layered hand-sewn gastrojejunostomy was created using a 3-0 absorbable barbed suture (V-Loc™) over a 40F ViSiGi 3D^®. The biliopancreatic portion of the omega loop was transected using a 60 mm SureForm stapler with a white load.

A 125 cm Roux limb was then measured distally. The jejunojejunostomy was created using a 60 mm SureForm stapler with a white load and the common enterotomy was closed with a 3-0 absorbable barbed suture (V-Loc). The mesenteric defect was then closed with a running nonabsorbable suture. An air leak test was then performed after the Roux limb was occluded.

Results:

The patient had an uneventful postoperative course and was discharged home 24 hours after surgery tolerating a bariatric clear liquid diet. At 6 weeks, the patient was tolerating a solid diet and her body mass index decreased to 43.1 kg/m² (weight 132.3 kg) with a 17.4% excess body weight loss.

Conclusion:

The robotic approach to Roux-en-Y gastric bypass is a safe and effective approach to the surgical management of morbid obesity with adequate early weight loss.

Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

No competing financial interests exist

.

No funding was received for this article.

Runtime of video: 10 mins 00 sec