Robotic Weight-Loss Surgery Passes Test
But method is time-consuming and unnecessary, one expert says
MONDAY, Aug. 15, 2005 (HealthDayNews) -- Using robotic arms to perform gastric bypass surgery may be the future of this increasingly popular weight-loss procedure, researchers report.
Dramatic weight loss with gastric bypass is achieved by reducing the size of the stomach, and is usually done by a minimally invasive procedure called a laparoscopic Roux-en-Y procedure.
However, this procedure is considered one of the more difficult laparoscopic procedures, the researchers noted, and usually requires 75 to 100 operations before even experienced surgeons achieve the highest level of proficiency.
The new robot procedure "allows surgeons to get more proficient more quickly," said lead researcher Dr. Myriam J. Curet, an associate professor of surgery at Stanford University Medical School. With the robotic procedure, it takes five to 10 operations to master the technique, she added.
In a new study, researchers report the results using a new robot procedure in 10 patients who underwent a totally robotic laparoscopic Roux-en-Y gastric bypass surgery. The new technique minimizes the need to reposition the robot during the procedure, which had made the robot technique difficult to use in the past.
"We did the study in order to see if we could develop a technique using the robot for the entire gastric bypass," Curet said. "We found that we could develop a technique that was safe and that seems to indicate that it is a better alternative, especially during the first part of the learning curve, in terms of doing it in a timely fashion."
The report appears in the August issue of the Archives of Surgery.
In the study, Curet's team compared the results of the robotic procedures with the outcomes of 10 patients who had undergone standard laparoscopic Roux-en-Y gastric bypass surgery. During robotic surgery, the surgeon performs laparoscopic gastric bypass from a remote console by controlling up to three robotic arms and a binocular camera.
Curet believes the main advantage of the robotic procedure is that it can make the gastric bypass procedure easier and quicker to learn than with the standard laparoscopy. For new surgeons learning the procedure, using the robot cut the time to do the procedure from 208 minutes with standard laparoscopy to 169 minutes using the robot, the researchers found.
In addition, the system is easier for the surgeon in terms of physical strain. "With the robot, there is a lot less skeletal strain for the surgeon, a lot less neurotherapies, so it's much easier to do more cases in one day," Curet said.
Curet believes that robotic gastric bypass will become a viable option for patients looking to have gastric bypass surgery. "If patients have the opportunity to have it done robotically, they should consider that," she said. "Any time you can reduce operative time and the learning curve, and any time you make the operation technically easier, which I think the robot is doing, there is an advantage to the patient."
But one surgeon who performs laparoscopic Roux-en-Y gastric bypass surgery daily thinks the robot has no place in the future of gastric bypass surgery.
"The robot has classically been the technology looking for a market," said Dr. Mitchell S. Roslin, director of Obesity Surgery at Lenox Hill Hospital in New York City. "For experienced laparoscopists doing gastric bypass, it does absolutely nothing."
The advantage of the robot is that it gives the surgeon three-dimensional visualization and greater range of motion with the wrist, Roslin said. "Both of those things people working with laparoscopy have compensated for years ago," he noted.
The main usefulness of the robot is in applying it to a laparoscopic procedure, such as prostate surgery, where the laparoscopy is new and surgeons are just being trained. In this instance, using the robot makes the procedure easier to learn and is probably faster, Roslin admits.
But in gastric bypass, where surgeons have to be proficient in laparoscopy, using the robot isn't necessary. "We have a robot," Roslin said. "We do 1,000 gastric bypasses a year, and we don't use the robot for any of them. It would just slow us down."
The National Institute of Diabetes and Digestive and Kidney Diseases can tell you more about gastric bypass surgery.