Robotic Technique Shows Promise In Weight Loss Surgery

Weight Loss Surgery

Surgeons at the Stanford University School of Medicine have developed a safe and efficient way to use a surgical robot to perform gastric bypass operations. Their report, published in the August issue of the Archives of Surgery, documents the first totally robotic technique to complete this technically challenging procedure.

The method, developed by associate professor of surgery Myriam Curet, MD, is an improvement on a more conventional technique called laparoscopic surgery. In both instances, specialized tools with cameras attached are inserted through small holes in the patient's body. But while traditional laparoscopic tools are held in the surgeon's hand, the robotic tools are operated remotely from a control station.

"It makes the surgery easier," said Curet, noting that the da Vinci robotic surgical system, manufactured by Intuitive Surgical Inc. in Sunnyvale, Calif., offers several advantages over hand-held laparoscopic tools. For example, it has a 3-D camera to aid visualization, as opposed to the 2-D fiber optic cameras used in the conventional tools. The robotic arms also have highly flexible wrists, making precise maneuvers possible.

The robot also offers a benefit specific to gastric bypass surgery, which is often performed on morbidly obese patients: the robotic arms are strong enough to stay steady while working in these patients' massive abdomens. "The robot minimizes the torque of the abdominal wall," Curet explained, decreasing the chance that the surgeon would have to switch to open-cavity surgery midway through the procedure.

Gastric bypass is the most common form of weight loss surgery. It drastically reduces the stomach's size to limit the amount of food intake, and also bypasses a significant portion of the small intestine, cutting down on nutrient absorption.

As the obesity epidemic has grown in recent years, so too has the number of gastric bypass operations. In the United States alone, the number of surgeries increased from 29,000 procedures in 1999 to about 141,000 in 2004, according to the American Society for Bariatric Surgery. The procedure poses about a 2 percent risk of mortality and requires lifelong changes in eating habits. But for many morbidly obese individuals, the operation is life-saving.

Gastric bypass procedures are notorious among surgeons for being technically complicated and difficult. Curet and her colleagues therefore wanted to develop a protocol to make the surgery easier on both the patient and the surgeon. To investigate whether the robotic system could safely and effectively streamline the process, the authors compared the results of 10 robotic surgeries with 10 conventional laparoscopic procedures.

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