Introduction: Gastric Electrical Stimulation (GES or Enterra® Therapy) is a low morbidity treatment option that may be effective for refractory symptoms in patients with gastroparesis of diabetic or idiopathic etiology. During surgery to initiate GES, 2 electrodes are tunneled in the muscular wall of the gastric antrum in a precise location. If these electrodes pass through the mucosa and into the gastric lumen as confirmed on endoscopy, they must be repositioned, often multiple times. During this procedure, anchors proximal and distal to the electrodes must be sutured to the gastric wall as well. Robotic surgical systems may provide surgeons with several technical and ergonomic advantages during this procedure when compared to a standard laparoscopic approach.
Methods: The initial procedures in our clinical series were performed laparoscopically. More recently, all GES electrodes have been implanted robotically. Demographics, operative time, and endoscopically confirmed electrode mucosal perforations were quantified and compared based on operative approach. During surgery, gastrostomy tube sites were taken down from the abdominal wall and closed, and jejunostomy tubes were placed when clinically indicated.
Results: A total of 20 patients underwent the minimally invasive placement of GES electrodes (15 laparoscopic and 5 robotic). Patients were similar in terms of age and sex. One laparoscopic patient and 2 robotic patients required closure of an old gastrostomy tube site. One laparoscopic patient has a jejunostomy tube placed. Mean robot set-up time was 12.6 minutes (10-15 minutes). There were no complications or conversions.
Conclusions: Robotic implantation of GES electrodes is feasible and safe. Operative time is not increased compared to laparoscopic techniques, and mucosal perforations on first pass during electrode placement are decreased. In our experience, the robotic technique is the preferred approach.
Program Number: P387