Robotically-Assisted Laparoscopic Biliopancreatic Diversion With Duodenal Switch. the Utility of Robotic System in Bariatric Surgery

Iswanto Sucandy, MD, Gintaras Antanavicius, MD FACS. Department of Surgery, Abington Memorial Hospital, Abington, Pennsylvania

Introduction : Biliopancreatic diversion with duodenal switch (BPD/DS) is considered the most effective surgical option for morbidly obese patients. Several techniques have been described – open, laparoscopic, and combination of open and laparoscopic. There are only few centers in the United States that perform robotically-assisted laparoscopic BPD/DS and published literature describing outcomes of this technique is also limited. In this study we describe our experience of this approach as a safe alternative for treatment of morbid obesity especially in the super-obese.

Methods : A prospectively maintained database was reviewed in all patients who underwent robotically-assisted laparoscopic BPD/DS between December 2008 and July 2011. Patient characteristics, perioperative complications (Major-anastomotic leak, hemorrhage, intraabdominal organ injury, and thromboembolic events ; Minor-superficial skin infection, others) , outcomes, and benefits of this technique were analyzed.

Results : A total of 107 consecutive patients (F:M=83:24) were included in this series. Average age was 44.76 years (range 20-67), BMI 49.97 (range 37-70) and the number of preoperative comorbidities was 6.24 (range 3-11). Mean operative time for a typical BPD/DS with appendectomy was 264 minutes (range 192-413) , which increased to 298 (range 210-463) minutes when lysis of adhesion was necessary. All cases were successfully completed using minimally invasive approach. There were no intraoperative or 30-day major postoperative complications. Two patients had to return to the operating room : one for an endoscopic release of an inadvertently-sutured nasogastric tube during creation of the duodenoileal (DI) anastomosis and another for significant port site infection. Minor postoperative complications included carpal tunnel syndrome exacerbation (n=1), which did not require surgical intervention. Median length of stay was 3.0 (2-13) days. Two outliers stayed for 9 and 13 days due to carpal tunnel syndrome exacerbation and port site infection, respectively. Two patients were readmitted within 30-days due to fluid retention and incarcerated umbilical hernia. Percentage of excess body weight loss (EBWL) at 1,3,6,9,12, and 18 months were 18.9, 36.4, 54.5, 67.4, 73.9, 82.42 respectively. No BPD/DS related reoperation or mortality occurred in this study. Improved ease of operation, visualization, precision, and range of motion especially during creation of critical anastomosis are the advantages of this technique.

Conclusions : Robotically-assisted laparoscopic BPD/DS is a feasible, safe, and effective alternative for weight loss surgery with excellent outcomes.