Robotic-Assisted gastrojejunal anastomosis does not improve results of laparoscopic Roux-en-Y gastric bypass

Aims: To describe surgical results in morbidly obese patients submitted to laparoscopic Roux-en-Y gastric bypass with robotic gastrojejunal anastomosis using the daVinci Surgical System. Methods: Between September 2003 and September 2008, 86 patients (24 males and 62 females) who fulfilled the NIH criteria for bariatric surgery have undergone robotic-assisted laparoscopic Roux-en-Y gastric bypass. Mean age was 43.4 years (24-62), mean preoperative weight 130.3 kg (83- 232) and mean BMI 47.9 kg/m (33.7-78.2). 56 patients (65.1 % ) had previous abdominal surgery; 9 patients had previous bariatric procedures (7 gastric banding, 1 vertical banded gastroplasty and 1 gastric pacing). Comorbidities included hypertension, 54.7 % ; type 2 diabetes, 30.2 % ; gastroesophageal reflux disease, 38.4 % ; obstructive sleep apnea, 25.6 % ; osteoarthritis, 33.7 % . Results: All procedures were completed laparoscopically. Intraoperative procedures included adhesiolysis, 13.9 % ; cholecystectomy, 5.8 % ; gastric band removal, 8.1 % and gastric pacemaker removal, 1.2 % . Mean operative time was 254.9 minutes (90-470); the robotic operative time and the system setup time were 54.5 minutes (30-125) and 10.1 minutes (7-17), respectively. Mean hospital length of stay was 8.6 days (4-65). No mortality was reported. 5 patients (5.8 % ) presented major early complications: 2 anastomotic leaks, 1 perianastomotic ulcer, 1 small-bowel perforation and 1 small-bowel obstruction. 11 patients (12.8 % ) presented major late complications: 5 perianastomotic ulcer, 1 anastomotic stenosis that required S145 endoscopic dilatation, 4 internal hernias with small-bowel obstruction and 1 late small-bowel perforation. In total, re-operation was required in 7 patients (8.1 % ); all re-interventions were succesfully performed laparoscopically. Mean excess weight loss was 49.7 % , 61.4 % , 64.5 % and 60.5 % at 6, 12, 24 and 36 months respectively. Conclusions: The Roux-en-Y gastric bypass can be effectively performed using the daVinci System. In our opinion, robotic techniques facilitate the creation of a completely hand-sewn gastrojejunostomy. Nevertheless, the robotic approach is burdened by a greater operative time and equipment costs, and it does not seem to provide a real advantage over standard laparoscopic techniques.