Robotically Assisted Single Anastomosis Duodenoileal Bypass after Previous Sleeve Gastrectomy Implementing High Valuable Technology for Complex Procedures.

Ramon Vilallonga,Manel Armengol,Enric Caubet,José Maria Balibrea,Oscar Gonzalez,Andrea Ciudin,José Manuel Fort

doi:10.1155/2015/586419

Ramon Vilallonga, Manel Armengol + Show 5 more

Open Access

https://doi.org/10.1155/2015/586419

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Abstract

Staged bariatric procedures in high risk patients are a common used strategy for morbid obese patients nowadays. After previous sleeve gastrectomy, surgical treatments in order to complete weight loss or comorbidities improvements or resolutions are possible. One strategy is to perform a novel technique named SADI (single anastomosis duodenoileal bypass-sleeve). We present the technique for totally intracorporeal robotically assisted SADI using five ports and a liver retractor. We aim to see if the robotic technology offers more advantageous anastomosis and dissection obtained by the robotic approach in comparison to standard laparoscopy. The safety, feasibility, and reproducibility of a minimally invasive robotic surgical approach to complex abdominal operations such as SADI are discussed.

Highlights

IntroductionSleeve gastrectomy (SG) constitutes the first stage of the duodenal switch and of the SADI-S (single anastomosis duodenoileal bypass-sleeve) procedure [1]
Sleeve gastrectomy (SG) constitutes the first stage of the duodenal switch and of the SADI-S procedure [1]
We aim to see if the robotic technology offers more advantageous anastomosis and dissection obtained by the robotic approach in comparison to standard laparoscopy

Summary

Introduction

Sleeve gastrectomy (SG) constitutes the first stage of the duodenal switch and of the SADI-S (single anastomosis duodenoileal bypass-sleeve) procedure [1]. SADI bypass includes a single duodenoileal anastomosis performed 300 cm from the ileocecal valve (Figure 1(a)). An extra 5 mm trocar was placed in the left iliac fossa With this set-up in place, the left 8 mm robotic trocar could be used through the 12 mm trocar in a double-cannulation technique which allows deciding the best direction to perform the stapling of the duodenum (Figure 1(b)). The duodenum was left in place and the buttress material reinforcement material located on the gastric part was cut by the use of robotic scissors (Figure 2(b)). For this maneuver, the console surgeon blocks the outlet at the level of the ileal loop in order to visualize the shape, the apparent volume, and any leak of the anastomosis (Figure 3(c)). A drain was left in place under the anastomosis and close to the duodenal stump (Figure 3(d))

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