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Revision Of Gastric Band To Sleeve Gastrectomy: Totally Robotic Approach

Jeremy M Linson, MD, Michael Latzko, MD, Ziad Awad, MD, FACS, Bestoun Ahmed, MD, FRCS, FACS, FASMBS. University of Florida College of Medicine Jacksonville

We present a case of revision of gastric band to sleeve gastrectomy, using a totally robotic approach, performed on a 65 year old female with BMI 57 and a history of laparoscopic gastric band placement. The patient did not tolerate band filling due to intractable nausea and vomiting and after 4 years continued to gain weight. The operation began with placement of the assistant port, and diagnostic laparoscopy. Then robotic trocars and a liver retractor were placed, and the robot was docked.

The operation began with brief lysis of adhesions and dissection of the band using robotic scissors. The band was unlocked, removed from its capsule and placed in the right upper quadrant, until retrieval prior to undocking. The capsule was then divided using the robotic vessel sealer, restoring the anatomic contour of the stomach. Next, a defect was created in the gastrocolic omentum close to the greater curvature using the robotic vessel sealer, and this defect was extended along the curvature to a point 4cm proximal to the pylorus, and then cephalad towards the spleen, taking down the short gastric vessels. The fundus was then completely dissected from left crus to the level of the gastroesophageal junction.

The robotic stapler was then deployed, and creation of the sleeve began 4cm proximal to the pylorus in a cephalad direction. Following the first stapler load, an EGD scope was introduced and guided toward the gastric antrum. Using the scope as a guide, stapler loads with tissue buttressing material were fired sequentially toward the gastroesophageal junction, keeping 0.5cm of the stomach attached to the gastroesophageal junction. The gastrocolic omentum was then sutured to the posterior wall of the stomach in a running fashion using robotic needle driver.

The staple line was checked for hemostasis and the specimen and port were removed. The patient was advanced to clear liquids 4 hours post-operatively and was discharged home POD2. At 4 month follow-up, the patients BMI decreased to 47, representing approximately 20% total weight loss.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 79480

Program Number: V202

Presentation Session: Video Loop

Presentation Type: VideoLoop

38

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