Bariatric surgery is often performed laparoscopically, which is minimally invasive, often only requiring incisions up to ten inches long. As technology advances, robotic surgery has become more common in many procedures, including lap band bariatric surgery and other bariatric surgeries.. In the United States, there has been a 23% increase rate per year in the number of general surgeries using robotics. Robotic surgery allows the surgeon to be more precise and may reduce complications following bariatric surgery.
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Overview of Robotic Bariatric Surgery
As robotic surgery technology advances, more bariatric surgeries are being performed using robotic systems. Robotic surgery works by creating a small incision in the abdomen, and then using a robotic platform to assist with the surgery. Surgeons are able to be more precise, reducing complications and improving recovery times. Robotic surgical systems show a magnified 3-dimensional view, allowing for greater precision in tissue manipulation. In one study, complication rates overall were 13.3% in laparoscopic gastric bypass while it was 12.2% in robotic gastric bypass. However, there are cost and training challenges associated with robotic surgeries. Significant financial investment and specialized training for surgeons is needed in order to see success rates with the technology.
Types of Robotic Bariatric Procedures
Robotic technology can be used to complete a variety of bariatric procedures. Robotic gastric bypass is the most common procedure used for morbid obesity and the majority of robotic bariatric literature available is related to it. This procedure is restrictive and malabsorptive, resulting in significant weight loss.
Robotic sleeve gastrectomy involves removing 60-80% of the stomach and turning it into a sleeve-like organ. This procedure leads to weight loss by reducing food intake and decreasing hunger hormones.
Robotic adjustable gastric banding involves placing a band around the upper portion of the stomach to create a small pouch. This small pouch limits food intake to about an ounce at a time. This was the first bariatric surgery to be performed robotically. Due to the simplicity of the gastric banding procedure, the robotic technology does not seem to provide any benefit besides slightly shorter operating room times. Additionally, adjustable banding has decreased significantly due to high revision and complication rates.
Advantages of Robotic Surgery
The benefits of robotic surgery strongly correlate with the training and level of experience of the surgeon. In a study that assessed surgeon experience and postoperative complications, it was found qualified surgeons (defined by performing more than 20 robotic surgeries) had 64% less complications than in-training surgeons (defined by performing less than 20 robotic surgeries).
The robotic system offers greater dexterity and control, allowing for more precise and delicate movements and a better view of the surrounding organs. Robotic surgery reduces recovery time and scarring because of the smaller incisions and less trauma to the body. In a study that compared 30-day outcomes of robotic gastric bypass and laparoscopic gastric bypass, the robotic procedure resulted in a significant reduction in post-operative bleeding, fewer requirements for blood transfusions, shorter length of stays, and a reduction in leaks and renal complications. This aligns well with the latest bariatric procedures trends focusing on minimally invasive techniques.
Comparison of Robotic Surgery with Traditional Techniques
Traditional bariatric surgery techniques include laparoscopic and open. Open bariatric surgery involved creating a large incision in the abdomen in order to access the digestive tract. Today, only about 3% of all bariatric surgery cases in the United States. With more technology available, most surgeries are now being performed laparoscopically, which is considered one of the least invasive bariatric surgery options.. Laparoscopic surgery creates a smaller incision than open surgery, yet robotic surgery provides an even smaller incision and greater dexterity than both laparoscopic and open surgery. With the ability to make more precise movements compared to traditional techniques, robotic procedures offer improved outcomes in complex cases.
Laparoscopic bariatric surgery is often more accessible due to lower costs and the widespread availability of trained surgeons. Robotic surgery can be cost-prohibitive. When comparing laparoscopic and robotic surgeries, robotic surgeries are typically $4,000-$6,000 more than laparoscopic.
Candidate Selection for Robotic Bariatric Surgery
Candidates for robotic bariatric surgery are similar to those for laparoscopic or open bariatric surgery. Individuals with a BMI over 40 or over 35 with obesity-related health issues are often indicated for robotic bariatric surgery. Individuals with severe obesity, defined by a BMI over 40, may benefit from robotic surgery due to the increased control the surgeon has over the movements. Candidates must be healthy enough to undergo surgery; those with severe heart or lung issues may not be suitable.
Similar to traditional techniques, candidates must demonstrate a willingness to adhere to post-surgery dietary and lifestyle changes to ensure long-term success.
Preoperative Preparation and Postoperative Care
Preoperative Preparation
Patients are often required to meet with a dietitian to begin adapting to the dietary changes necessary after surgery. Prior to surgery, a 2-4 week period of consuming liquid or low-calorie food items is typically recommended to shrink the liver, reduce the complexity of the procedure, and increase insulin sensitivity. Bariatric protein shakes are often included in the diet during this period to aid in preoperative weight loss.
Increasing physical activity prior to surgery can also help with preoperative weight loss and increase the adherence to physical activity post operation. Some programs may require a specific amount of weight loss prior to surgery in order to minimize surgical risks and improve outcomes.
Medical and psychological evaluations are also important in the preoperative period. Medical evaluations often involve blood tests, ECG, and imaging studies in order to assess the patient’s overall health and readiness for surgery. A psychological assessment ensures that the patient is mentally prepared for the lifestyle changes and has realistic expectations regarding the surgery’s outcomes.
Postoperative Care
Following robotic bariatric surgery, postoperative care is very similar to the care that will be received from traditional methods, with the only difference being a possible decrease in hospital stay and a reduced need for appointments that are related to surgical complications.
Patients will have regular follow-ups with a dietitian to assess postoperative nutritional needs.
Patients are required to follow a strict diet that consists of liquids immediately following surgery and slowly progresses to solid foods over several weeks. Lifelong vitamin and mineral supplements may be needed depending on the type of bariatric surgery. The most common nutritional deficiencies include iron, folate, B12, selenium, and calcium. It is important to chew food thoroughly, consume small amounts of food at a time, limit high amounts of sugar and fat, and consume adequate protein.
Bariatric multivitamins are crucial to address common deficiencies after bariatric surgery. Bariatric vitamins, including options such as bariatric vitamins chewable or liquid bariatric vitamin, help maintain adequate levels of essential nutrients. Bariatric multivitamin with iron and bariatric calcium chews may also be prescribed depending on individual needs. For hair health, some patients consider bariatric vitamins for hair loss.
Pain is generally less severe following robotic bariatric surgery due to the minimally invasive nature of robotic surgery, but patients will still receive medications to manage discomfort during the initial recovery period.
Patients are encouraged to start walking soon after surgery to reduce the risk of blood clots. Full physical activity can typically resume within a few weeks, depending on the individual’s healing process. Lifelong physical activity changes must be adhered to in order to keep weight off, with a general recommendation of 150 minutes of moderate-intensity physical activity per week.
Regular follow-ups are necessary to monitor weight loss progress, nutritional status, and potential complications
Future of Robotic-Assisted Bariatric Surgery
Robotic surgery continues to advance and improve. The current available robotic surgery is the Da Vinci system, which requires surgeons to control the robot. Currently, the advancement of autonomous robotic surgery is being experimented. This system implies the robot can make decisions and execute complex surgical tasks independently. With an increased use of AI, this has the potential to enhance precision, limit human error, and increase outcomes. Additionally, as robotic surgery continues to be explored and improved, eventually advancements may allow for more personalized procedures tailored to individual patient anatomy and health conditions. More hospitals may choose to adopt robotic technology as it becomes more affordable and widespread.
Conclusion
Robotic surgery is appealing because it offers greater precision and a lower complication rate compared to traditional methods. However, the technology has drawbacks, including higher costs and the extensive surgeon training required to achieve results that surpass those of standard bariatric surgery. As research and popularity around robotic surgery continue to grow, it’s possible that more hospitals will adopt this technology.
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