Totally Robotic Biliopancreatic Diversion with Duodenal Switch

Ranjan Sudan, MD, Erica R Podolsky, MD. Duke University Medical Center.

Background The biliopancreatic diversion with duodenal switch (BPD/DS) is a very effective but technically complex bariatric operation. We performed the first robotic BPD/DS in Sept 2000. Since the BPD/DS is performed in three different quadrants of the abdominal cavity and the robot has limited range of movement, initially, we used a hybrid laparoscopic-robotic technique to perform this operation. The robot was only used to perform the hand sewn proximal duodeno-ileal anastomosis. More recently we have modified the technique to perform all parts of the operation with a single dock. This is the first description of the technique to our knowledge.

Methods: Five ports are placed. One is supra-umbilical. Remaining ports are in the right and left anterior axillary and mid-clavicular lines. Ileum is marked at 100 cm and 250 cm from the ileocecal valve. Bowel at the 250 cm mark is attached to the anterior abdominal wall and subsequent operation performed robotically. The duodenum is divided 4 cm from the pylorus and a sleeve gastrectomy performed. Duodeno ileal anastomosis is hand sewn. The biliary limb is divided at the 250 cm mark and anastomosed to the common channel at 100 cm. Enterotomy for the stapler and mesenteric defect is closed robotically.

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