Courtney Cripps, MD, James Taggart, MD, Julio Teixeira, MD, FACS. Northwell Health-Lenox Hill Hospital
This video details the robotic single anastomosis duodenal switch performed in a 27-year-old female patient with morbid obesity, diabetes mellitus, asthma, and obstructive sleep apnea. The purpose of the presentation is to demonstrate the effectiveness of robotic assisted surgery as it obviates surgical positioning dilemmas in regards to the limited perspective and physical reach of laparoscopy as well as the improved manipulation of surgical instruments due to their inherent flexibility.
The video details port placement, a standard approach involving three 8mm ports, one 12mm port, a liver retractor, and an assist port. The operation begins with a dissection of the greater curvature with careful attention to maintaining the integrity of the gastroepiploic vessels prior to transection of the short gastric arteries. The proximal dissection terminates at the hiatus. Distal dissection continues beyond the pylorus to the duodenal bulb where the dissection is completed circumferentially to allow for transection of the duodenum.
Next, the gastric sleeve is created, and the omentum is re-approximated to the greater curvature. The duodenum is then transected, and the distal bowel site for anastomosis is obtained after identifiying the ileocecal junction and traveling 300cm proximal to that point.
The anastomosis is then created after formation of the enterotomies, using a hand-sewn, double-layer technique. Upon completion of the anastomosis, an air insufflation test is performed to reveal any defect in the bowel continuity.
Again, the purpose of the video is to demonstrate the feasibility of the robot in performing advanced technical surgery. The signle anastomosis duodenal switch serves as the ideal robotic operation given the superior visualization and articulation when compared to the dimensional constraints of laparoscopy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80474
Program Number: V092
Presentation Session: Bariatric Video Session
Presentation Type: Video