Robotic-Assisted Laparoscopic Biliopancreatic Diversion, Vertical Sleeve Gastrectomy with Traditional Roux-en-Y Duodenal Switch.

BACKGROUND: Although effective, duodenal switch can be a complicated and time-consuming operation for surgeons. PURPOSE: The purpose of this article is to present our technique of biliopancreatic diversion and vertical sleeve gastrectomy, creating a 150-cm common channel and a 100-cm alimentary limb. MATERIAL AND METHODS: A robot-assisted technique was utilized in creating a biliopancreatic diversion and vertical sleeve gastrectomy. RESULTS: Laparoscopy was used for marking stitches and then the robot was docked. After creating a window behind the duodenum, sleeve gastrectomy is performed followed by duodeno-ileal anastomosis and ileo-ileal anastomosis. CONCLUSION: With the adoption of robots and the described technique, it can be easier to be achieved in less time.

Second-stage robot-assisted biliopancreatic diversion with duodenal switch after sleeve gastrectomy.

Biliopancreatic diversion (BPD) was initially described in 1979 and consisted of a distal gastrectomy with a 250-mL stomach pouch and a distal intestinal bypass with a 50 to 100-cm common channel resulting in malabsorption of dietary fat (Scopinaro et al. Br J Surg. 66(9):618-20, 1979). Later, several modifications (sleeve gastrectomy, pylorus preservation, and duodenal switch) were proposed to improve incidence of postoperative dumping syndrome, diarrhea, and anastomotic ulcerations (Lagacé et al. Obes Surg. 5(4):411-8, 1995). Gagner et al. developed a simplified and reproducible approach for laparoscopic BPD with duodenal switch (BPD-DS) after sleeve gastrectomy (Ren et al. Obes Surg. 10(6): 514-23, 2000). BPD-DS has been considered as one of the most difficult bariatric procedures for its surgical complexity and postoperative metabolic complications management. In this regard, the number of BPD-DS has remained extremely low (<4 %). We hypothesize that robotic approach could facilitate the feasibility of BPD-DS procedure. In this multimedia video (8 min), we present a step-by-step robotic BPD-DS.

Hand-assisted laparoscopic bariatric surgery.

Bariatric surgery implies a major life-long rearrangement of the gastrointestinal tract to obtain a controlled weight reduction in a severe but nonmalignant disease. Obesity poses a special challenge to the laparoscopic surgeon. Laparoscopy is known to facilitate the perioperative phase for the patient, but is technically difficult to perform in morbidly obese subjects. Hand-assistance adds extra control in demanding procedures, and Hand-port systems for use in the thick abdominal wall are now available. Here we review the role of hand-assisted laparoscopy for common bariatric procedures and describe our technique for Hand-assisted laparoscopic Roux-en-Y Gastric bypass. Hand-assistance might be the well-blended mix for complex laparoscopic procedures in bariatric work, especially for surgeons working outside highly specialized laparoscopic centers.

The Elite II Bariatric Surgery Retractor system: a recent addition to the bariatric surgeon's tool chest.

BACKGROUND: A good surgical retractor is essential for facilitating bariatric surgery. Recently, Thompson Surgical Instruments designed a new system specifically for bariatric surgical procedures. METHODS: The Elite II Bariatric Retractor system was evaluated in 50 successive bariatric surgical patients. We had the opportunity to modify and improve several major components. We report our experience with this modified retractor system. RESULTS: This system proved to be safe, easy to use, durable, and useful in patients of all BMIs, following modifications and improvements to standard parts. CONCLUSION: This new bariatric retractor system is an improvement over prior bariatric retractor systems being used.