Totally robotic staplerless sleeve gastrectomy

Jacob A Petrosky, MD1, Valerie Zeer2, Tomasz Rogula, MD2. 1Cleveland Clinic Foundation, 2University Hospitals Case Medical Center

Objective of the technology or device: 
To provide an alternative to expensive endoscopic surgical stapler devices in performance of laparoscopic or robotic sleeve gastrectomy by use of a bipolar electrocautery device (Vessel Sealer™ ) as an alternative to endoscopic stapling devices.

Description of the technology and method of its use or application:
An experimental study randomized 10 pigs to control or study groups at the time of the procedure. In the control group, totally robotic laparoscopic sleeve gastrectomy (TRLSG) was carried out utilizing robotic fired endoscopic 60-mm stapler for resection of the greater curve with oversewing of the staple line by 3-0 suture. In the study group, a robotic controlled bipolar-coagulation device, (Vessel Sealer™) was used for transection of the greater curve, and a robot sewn two-layered closure of the of the anterior and posterior stomach walls was carried out with 3-0 absorbable suture. On Postoperative day 14 all subjects were euthanized and tubular stomachs extracorporealized for pressure testing and histologic analysis.

Preliminary results if available:
Longer procedure time was seen with the study group (69 minutes vs. 117 minutes). Stapler line bleeding, was more frequent with the linear stapler 4/5 (80%) vs 0/5 (0%). Linear stapler was more effective at transection and closure of the tubularized stomach while use of the Vessel-Sealer™ was less effective. There were no post-operative complications control group. In the study group feeding problems, slight apathy, leg pain and vomiting were seen. At post-mortem exam, no evidence of leak, abscesses, or fistula were noted in either group. Formation of adhesions was less in the study group (2/5) compared to the control group (5/5). None of the specimens in either group leaked when filled with an aqueous solution to predetermined pressure of to 100 mmHg.

Conclusions / future directions.
This study demonstrates the technical feasibility of performing a totally-robotic staplerless sleeve gastrectomy. Improvements in tissue sealing technology may reduce intraoperative bleeding complications, and may lead to a dramatic reduction of operative costs associated with performance of laparoscopic sleeve gastrectomy. This despite lack of complications, study does not demonstrate safety of the procedure however.

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