Weight-loss surgery, also known as bariatric surgery, is one of the most transformative procedures for patients struggling with obesity. It changes a patient's appearance, eating habits, and can profoundly affect their physical and psychological well-being. Robotic bariatric surgery is a modern, minimally invasive procedure for effective weight loss using robotic technology. It offers numerous benefits like greater surgical precision, shorter recovery times, less pain, and fewer complications. Bariatric surgery is a life-changing option for individuals struggling with obesity and its related health complications. With the advancement of medical technology, robotic bariatric surgery is becoming increasingly popular as a safer, more precise alternative to traditional surgical methods.
What is Robotic Surgery?
Robotic surgery is an approach healthcare providers use for minimally invasive procedures. The technology consists of three main parts:
- Robotic arms that hold tiny instruments.
- A high-definition camera that provides enhanced, magnified, 3D views of the surgical area.
- A surgical console where your surgeon controls the instruments and the camera’s every move. The controls look similar to joysticks on an arcade game.
Robotic surgery doesn’t replace your surgeon. It’s just one of many methods they use to do procedures. Surgeons must complete additional, specialized training to do robot-assisted procedures. Some surgeons pursue formal training through minimally invasive and robotic surgery fellowships.
Many specialists use robot-assisted surgery, including general surgeons, brain and spinal surgeons, cardiothoracic surgeons, colorectal surgeons, gastrointestinal surgeons, gynecologic surgeons, and urologists. Some of the most common types of robot-assisted surgeries include appendectomy, colectomy, epilepsy surgery, gallbladder removal, gastric bypass, hernia repair, hysterectomy, mitral valve repair, pancreatectomy, and spine surgery.
The Evolution of Bariatric Surgery
Two decades ago, performing a gastric bypass was an open, technically difficult operation with big incisions, which put patients at increased risk for wound-related complications, hernias, and infections. Acceptance was limited. In the early 2000s, weight-loss surgeries - Roux-en-Y gastric bypass, sleeve gastrectomy, and lap band - began being performed laparoscopically. The minimally invasive tools and techniques meant smaller incisions for patients, less pain, and quicker recovery times, quickly becoming the gold standard. Now, the next frontier in bariatric procedures has arrived.
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How Robotic Bariatric Surgery Works
Robotic bariatric surgery is a minimally invasive weight-loss surgery performed using robotic technology-most commonly the da Vinci Surgical System. Like laparoscopic surgery, robotic surgery is a minimally invasive procedure performed through small incisions in the abdomen. The techniques used during robotic surgery are like the ones used during open, traditional surgery. The main difference is how your surgeon accesses the surgical area. Instead of making one large incision, your surgeon makes a few small incisions. Another difference is that the surgical instruments require less space to do their job. This limits the need to push tissue, muscle and organs aside.
During robotic surgery, your surgeon will:
- Make one or more small incisions.
- Place ports (thin tubes) through these incisions. The ports are like temporary tunnels for the surgical instruments.
- Attach the robotic device to the ports and place instruments through them.
- Place a long, thin camera (endoscope) through one of the ports. The camera provides high-definition, 3D images during the procedure.
- Control the robotic arm while sitting at a console a few feet away from you.
- Do your surgery.
- Remove the surgical instruments and ports.
- Close your incisions with sutures.
It's important to note that the robot does not perform the surgery; rather, the robotic system is a tool the surgeon uses to complete the operation. The surgical robot's four arms are positioned where needed in the patient's abdomen.
Types of Robotic Bariatric Procedures
Bariatric surgeons are now performing virtually all weight loss surgeries, such as sleeve gastrectomy and gastric bypass, with robotic surgical assistance.
- Gastric Bypass: The surgeon creates a small pouch in the top of your stomach that forms a “new stomach,” limiting the amount of food you can eat during a meal and helping you feel fuller sooner. The surgeon then creates a small opening, or stoma, in the pouch and attaches that opening to a section of your small intestine. The reconnected intestine causes food to bypass part of the intestine, so some of the nutrients and calories will not be absorbed. In gastric bypass, the surgeon uses surgical staples to divide the stomach and create a small upper pouch about the size of a golf ball.
- Sleeve Gastrectomy: The gastric sleeve, which is the most popular choice among patients, involves removing the stretchiest portion of the stomach, reducing it from the size of a football to the size of a small banana. After sleeve gastrectomy, the stomach holds about one-tenth its previous capacity. In sleeve gastrectomy, the surgeon removes a large portion of the stomach in a vertical fashion, leaving the organ about the size and shape of a banana or sleeve.
- Biliopancreatic Diversion with Duodenal Switch: A less common procedure recommended for people with a body mass index (BMI) greater than 50, there are two components. First, a smaller stomach pouch is created by removing about 60-70% of the stomach. Then the duodenum, the first part of the small intestine, is divided just past the outlet of the stomach. The surgeon also divides the last portion of the small intestine, and the remaining segment is and connected to the outlet just below the new stomach.
- Duodenal Switch: NewYork-Presbyterian's surgeons have been refining the use of robotic bariatric surgery to perform "duodenal switch," a complex procedure which promotes weight loss by combining sleeve gastrectomy with intestinal bypass.
Advantages of Robotic Surgery
Compared to traditional open surgery, robot-assisted surgery offers benefits like:
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- Less pain during recovery.
- Lower risk of infection.
- Reduced blood loss.
- Shorter hospital stays.
- Smaller scars.
Robot-assisted surgery offers advantages for your surgeon, too. For example:
- The robotic arm’s movements have a greater range of motion than a human hand. The arms rotate instruments in tight spaces in ways that wouldn’t be possible otherwise. Robotic surgery is more exact, due to a greater range of motion and stability and a vastly improved view of the surgical field (the area being operated on). The robot allows the surgeon to sit at a console with controls within easy reach. This prevents physician fatigue and offers more precise positioning during the procedure.
- A sophisticated camera provides magnified, high-definition views of the surgical area. The robot has 3D cameras that provide a very clear view for the surgeon.
- The small incisions and instruments allow surgeons to do the entire operation inside your body.
Success Rates and Outcomes
Robot-assisted surgery currently has an overall success rate of 94% to 100%. Individual success rates depend on what type of procedure you need, your general health and other factors.
One study examined the outcomes of a single surgeon who performed 809 metabolic and bariatric operations - 498 totally robotic and 311 laparoscopic - between 2020 and 2023. They found total robotic Roux-en-Y gastric bypass (RYGB) resulted in significantly shorter operative times (97.6 min. vs. 115.4 min), reduced hospitalization (1.19 days vs. 1.39 days), and lower complication rates (1.7% vs. Total robotic sleeve gastrectomy procedures produced similar benefits- less operative time (47.4 min. vs. 53.1 min.), shorter length of stay (1.14 days vs. 1.30 days), and fewer complications (0.8% vs. 3.2%).
In a second study, researchers report improved outcomes and efficiencies for robotic procedures involving patients, this time with severe obesity and type 2 diabetes. A total of 744 patients received either totally robotic (n= 469) or laparoscopic RYGB or sleeve gastrectomy (n=275). Major complication rates for patients with diabetes (2.4% vs. 8.3%), length of stay (1.19 days vs. 1.48 days) and operative times (71.7 min. vs. 90.5 min.) were all lower compared to laparoscopy and were comparable to rates seen with patients with no diabetes.
Disadvantages and Risks
Robot-assisted surgery is only available in centers that have specially trained surgeons.
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Other disadvantages include:
- Complications that would require your surgeon to “switch” to an open procedure with larger incisions. (An example is scar tissue from a past surgery, which makes robotic surgery more challenging.)
- Nerve damage and compression.
- Robotic malfunction, which is extremely rare.
- The learning curve: Robotic surgery uses newer technology. This means that not all surgeons have trained with the technology.
- No haptic feedback: With robotic surgery, the surgeon sits at a console and controls the robot, which is at the patient’s bedside. The surgeon does not feel the instruments touching the tissue.
- Because robotic surgery it so precise, it can take a bit longer.
As with any surgery, there are risks associated with robotic weight loss surgery.
Recovery After Robotic Bariatric Surgery
In general, recovery is much shorter compared to traditional surgery. Depending on the procedure type and your overall health, you may:
- Get out of bed shortly after the anesthesia wears off.
- Be able to eat within a few hours of surgery.
- Go home the same day or next day.
- Most patients resume normal activities within 2-4 weeks.
- Most patients who have robotic bariatric surgery can expect a two- to three-week recovery period after surgery. It is also important to follow your doctor’s instructions on how many calories you should be consuming during this period. It is important to commit yourself to a healthier lifestyle after any weight loss surgery.
You’ll receive at-home care instructions specific to the procedure you had. Here are a few general instructions:
- Take it easy for a few days or however long your surgeon recommends.
- Resume everyday activities gradually. If you’re not on prescription pain medications, you can start driving when you’re ready.
- Don’t lift anything heavy until you follow up with your surgeon.
- Watch for symptoms of infection (like warmth, pus or discoloration) near your incision site.
- Take medications for pain or constipation.
When to Call the Doctor
Tell your healthcare provider right away if you notice:
- Blood-soaked dressings.
- Fever.
- Yellowish discharge (pus) from your incision.
- Pain that doesn’t get better with medication.
- Blood clot symptoms, like swelling in your groin or lower leg.
- Nausea or vomiting.
Is Robotic Surgery Right for You?
Robotic surgery isn’t “better” than other types of surgery. It’s one of many approaches, and surgeons choose it on a case-by-case basis. They’ll consider factors like the type of surgery you need, your overall health, your surgeon’s expertise, and technological limitations. Patients who are severely obese may be candidates for robotic surgery. Severely obese is considered anyone with a Body Mass Index of greater than 40.
The Future of Robotic Bariatric Surgery
The utilization of robotic platforms is expected to increase. There are many companies working on making more, newer, and better robots for surgical use. A decade from now, I expect that there will be a robot in every operating room.