Jeremy M Linson, MD, Michael Latzko, MD, Ziad Awad, MD, FACS, Bestoun Ahmed, MD, FRCS, FACS, FASMBS. University of Florida College of Medicine Jacksonville
We present a case of a totally robotic Roux-en-Y gastric bypass using a single-dock technique, performed on a 51 year old female with a BMI of 38.66 and comorbidities including hypertension, diabetes mellitus, and gastro-esophageal reflux disease. The operation began with placement of the assistant port, and diagnostic laparoscopy. Then robotic trocars and a liver retractor were placed, and the robot was docked.
The angle of His was released and the pars flaccida was divided. A retro-gastric tract was created between the left gastric vessels and the lesser curvature, and a linear stapler was fired to begin creation of the gastric pouch. Then a gastric band calibration tube was passed trans-orally into the proximal stomach to size a pouch of 15mL. 2 more loads were fired to disconnect the fundus from the gastro-esophageal junction, keeping 1cm of the fundus attached. The omental transection was performed, and the transverse colon was mobilized cephalad, exposing the duodeno-jejunal flexure. The jejunum was measured to 50cm distal to the duodeno-jejunal flexure, and that loop was mobilized to the left upper quadrant and anchored to the gastric pouch with interrupted suture. The outer posterior layer of the anastomosis was sewn using 3-0 absorbable monofilament barbed suture. A stapled side-to-side anastomosis was then performed. The common enterotomy was approximated using absorbable monofilament barbed suture. Before tightening the suture, the gastric band calibration tube was advanced through the anastomosis to ensure appropriate sizing. The outer anterior layer was then sewn using the same suture in a running fashion.
Next, the biliopancreatic limb was disconnected from the Roux limb with a stapler, and the mesentery in between the Roux and biliopancreatic limbs was divided perpendicularly for 2cm. The Roux limb was then measured 150cm distal to the gastro-jejunostomy, and this was mobilized to the left upper quadrant and anastamosed to the biliopancreatic limb in side-to-side fashion with the robotic stapler. An anti-obstruction stitch was placed. Prior to completion, a leak test was performed and the Roux limb was checked for twisting, which was not present. The total operative time for this case was 180 minutes. The patient was advanced to a bariatric clear liquid diet 4 hours after the operation was complete, and was discharged home the following day. At 3 month follow-up the patient's weight decreased to 89.4kg, and the BMI was 32.3, representing 18% total weight loss.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79474
Program Number: V002
Presentation Session: Bariatric and Metabolic Surgery
Presentation Type: Video