Totally Robotic Biliopancreatic Diversion with Duodenal Switch

Ranjan Sudan, MD

Duke University Medical Center

Objective of the technology or device: To demonstrate the feasibility of a totally robotic biliopancreatic diversion with duodenal (BPD/DS).

Description of the technology and method of its use or application switch: BPD/DS involves operating in three different abdominal quadrants. This has traditionally been difficult without undocking and repositioning the robot. Therefore, we have been performing this procedure using a hybrid laparoscopic-robotic approach since 2000. Recently, we have modified our technique so that the entire procedure can be performed robotically with a single dock. We present the first series of totally robotic BPD/DS.

Methods: Thirty eight patients underwent totally robotic BPD/DS between November 2011 and January 2013. The common channel was 100 cm; alimentary limb was 250 cm, with an antecolic alimentary limb anastomosis. The sleeve was sized to be slightly larger than a 34 French bougie. A procedure video accompanies this presentation.

Preliminary results: The mean age of patients was 42 years with a mean preoperative BMI of 54 kg/m2. Mean length of stay was 4.5 days. All procedures were completed totally robotically with a mean operative time of 356 minutes. There were no mortalities and no leaks. Since the surgeon controlled the camera and could retract tissues for himself using the accessory arm, the need for experienced help bedside was minimized.

Conclusions/Future directions.
From a technical perspective a totally robotic procedure gives the console surgeon much greater control and the need for very experienced bedside surgeon is decreased. This is a real advantage in an academic setting where teams are constantly changing. Once robotic staplers become available, this procedure will rely on bedside assistance even less.


Session: Poster Presentation

Program Number: ETP040

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