Monoquadrant Robotic Roux-en-Y Gastric Bypass

Abstract

Background: While laparoscopic Roux-en-Y gastric bypass is one of the most commonly performed procedures for morbid obesity in the USA, robotic application has been viewed as a valid option. However, the technique is not firmly established with single robotic docking. The objective of this video is to demonstrate the technical details of performing a standardized monoquadrant robotic Roux-en-Y gastric bypass (RRYGB). Methods: Between April 2008 and May 2009, 15 patients meeting the NIH consensus criteria for bariatric surgery underwent a monoquadrant RRYGB. The data were prospectively collected in a dedicated bariatric database and reviewed retrospectively. The patient was positioned supine. Subsequent to creating a 30-ml gastric pouch using a series of endostaplers, the da Vinci robotic system (Intuitive, Sunnyvale, CA) was docked cranially. The robotic arms were attached in the double cannulation fashion. The gastrojejunostomy (GJ) was performed by a robot-assisted hand-sewn double-layered technique, followed by the creation of a jejunojejunostomy (JJ) with an endostapler. The common enterotomy of the JJ was closed with robot-assisted hand-sewn double-layered fashion. The bridge of jejunum between the GJ and JJ was transected separating both anastomoses. The mesenteric defect was not routinely closed at the end of the procedure. Results: There were 13 women and 2 men with a median age of 36 years included in this study. The procedure was successfully accomplished by a monoquadrant robotic technique in 14 cases (93. 3%). One case was converted to open procedure because of an intra-operative enterotomy by an endostapler. The mean operative time was 202 min (range 158-353 min). There was no postoperative complication, notably no GI leak or anastomotic bleeding. The median hospital stay was 2. 4 days (range 1. 7-4 days). The mean weight loss after 1 year was 38. 5 kg. Conclusions: This video highlights the feasibility of performing a standardized monoquadrant RRYGB in its entirety with single docking of the da Vinci robotic system. © 2011 The Society for Surgery of the Alimentary Tract.