Courtney N Cripps, MD, James L Taggart, MD, Caitlin P Olson, MD, Julio A Teixeira, MD, FACS. Northwell Health-Lenox Hill Hospital
We present the case of a 43-year-old female patient with a BMI of 71 who underwent a robotic duodenal switch after failing repeated attempts at weight loss through lifestyle modification. The particular relevance of this presentation lies in the technical considerations of the operation and the feasibility of the robotic platform.
The operation begins with dissection along the greater curvature towards the esophageal hiatus with ligation of the short gastric arteries. After the visualization of the hiatus, the dissection is carried distally towards the pylorus and duodenum. A circumferential dissection around the duodenum prepares the duodenum for transection. The robotic stapler is then used to create a gastric sleeve, and omentopexy is then performed. The duodenum is transected, and the small bowel is measured 300cm proximal to the ileocecal junction. This identified segment of bowel is then used to create the proximal or duodenoileal anastomosis. The common channel anastomosis is formed using a stapler approximately 100cm distal to the duodenoileal anastomosis. The biliopancreatic limb is divided in order to complete the duodenal switch configuration. The mesenteric defects are closed. A methylene blue test is used to confirm the absence of a leak. Given the need to access nearly all quadrants of the abdomen, the robotic platform allows these actions to be performed without requiring movement of the surgeon around the patient. By limiting the movement around the patient and the exchange of instruments to complete the neccesary steps of the operation, surgical efficiency is improved.
The robotic duodenal switch offers neutralization of weight loss in the super obese patient population, but it also neutralizes the operative playing field for a wide range of surgeons. The robotic platform may facilitate the transition from open to minimally invasive surgery, particularly in complex operations requiring multiple anastomoses.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88400
Program Number: V254
Presentation Session: Friday Video Loop (Non CME)
Presentation Type: VideoLoop
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