Bariatric Robotic Surgery: A Comprehensive Guide

154 Pages·2019·5.847 MB·English

by  Carlos Eduardo Domene, Keith C. Kim, Ramon Vilallonga Puy, Paula Volpe

Bariatric Robotic
Surgery
A Comprehensive Guide
Carlos Eduardo Domene
Keith C. Kim
Ramon Vilallonga Puy
Paula Volpe
Editors
123
Bariatric Robotic Surgery
Carlos Eduardo Domene
Keith C. Kim • Ramon Vilallonga Puy
Paula Volpe
Editors
Bariatric Robotic Surgery
A Comprehensive Guide
Editors
Carlos Eduardo Domene Keith C. Kim
Hospital São Luiz Itaim AdventHealth Celebration
São Paulo Celebration, FL
Brazil USA
Ramon Vilallonga Puy Paula Volpe
Universitat Autónoma de Barcelona Hospital São Luiz Itaim
Barcelona São Paulo
Spain Brazil
ISBN 978-3-030-17222-0 ISBN 978-3-030-17223-7 (eBook)
https://doi.org/10.1007/978-3-030-17223-7
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Preface
Bariatric and metabolic surgery is recognized to be an important and effective
option for the treatment of severe obesity and various associated conditions and
diseases. This book presents state-of-the-art knowledge on such surgery with the
aim of facilitating the sharing and exchange of knowledge, documenting effective
techniques, and enhancing safety and outcomes. All technical aspects are covered in
detail, and the text is complemented by many helpful illustrations. A further key
feature is the provision of accompanying surgical videos, which will be of value to
both novice and experienced surgeons. This book will be a great asset in surgical
practice for all who are involved or interested in bariatric and metabolic surgery.
The increasing prevalence of obesity in many countries means that it should now
be considered a pandemic. It is widely recognized that obesity increases the risk of
a variety of life-threatening conditions, including heart disease, diabetes, and hyper-
tension. Bariatric surgery is often the most effective way to treat such morbid obe-
sity. Nevertheless, while various bariatric procedures have been proposed, to date
standards have been lacking. In this book, the leading experts from around the world
discuss all aspects of bariatric surgery and present their own favored versions of
surgical procedures with the aid of informative illustrations. Technical nuances are
carefully described, and detailed attention is devoted to potential complications and
how to avoid them. The expertise of the authors and the range of techniques consid-
ered a guarantee that both trainees in bariatric surgery and experienced surgeons
will find this book to be an invaluable source of information and guidance in their
daily work.
While bariatric procedures were originally performed via open surgery, mini-
mally invasive techniques have largely replaced the open approach, and the advan-
tages of a minimally invasive approach have been well validated with reduced
postoperative pain, shorter hospital stay, and lower postoperative mortality. Despite
its general feasibility, there are a number of technical limitations associated with
performing laparoscopic surgery on obese patients including limited motion of lap-
aroscopic instruments due to a thick abdominal wall, hepatomegaly, and increased
amounts of intra-abdominal fat with limited workspace, reduced surgical dexterity,
and poorer ergonomics, placing significant musculoskeletal stress upon the surgeon.
v
vi Preface
Several publications from the field of gynecology have described clinical benefits of
robotic surgery when operating on obese patients. Interestingly, the first robotic
procedure was a robotic placement of an adjustable gastric band in 1998 using an
early version of the da Vinci® System prior to its actual market launch. Since then,
all of the commonly performed bariatric surgical procedures including Roux-en-Y
gastric bypass, adjustable gastric band, sleeve gastrectomy, and biliopancreatic
diversion with duodenal switch have been performed robotically and demonstrated
to be feasible and safe.
São Paulo, Brazil Carlos Eduardo Domene
Celebration, FL, USA Keith C. Kim
Barcelona, Spain Ramon Vilallonga Puy
São Paulo, Brazil Paula Volpe
Introduction
Robotic-Assisted Surgery: A Step Toward the Future
Laparoscopic surgery has been widespread from the 1990s and has shown exponen-
tial growth since then. Contributing to this were the obvious benefits of avoiding the
need for large abdominal incisions, less surgical trauma, less operative morbidity,
more rapid and smooth postoperative recovery, and high acceptance on the part of
patients who began to demand the technology. In addition, numerous surgeons
quickly adhered to laparoscopy, and there was a large cooperative effort worldwide.
There has been an unprecedented and widespread diffusion of knowledge, mainly
because the visualization of the surgical procedure on a monitor and its easy record-
ing and retransmission allowed everyone to see the surgeries live, or repeatedly on
videos, unlike open surgery.
Robotic-assisted surgery was introduced in 2000, and the indications for such
surgery have sharply increased since then. Surgeries via laparoscopic access can be
performed using a robot with greater accuracy and safety. The use of a robot favors
less invasive surgery, with much better visualization of components that are under-
going surgery, and allows close approximation of the structures being manipulated,
and the vision of the surgeon is in three dimensions; the procedure is less invasive
and leads to less tissue trauma.
The surgeon controls the movements of the robot, through a special console, and
determines all the movements of the tweezers and the camera. The tweezers have
more delicate movements, being literally controlled with the tips of the fingers. The
robotic interface between the surgeon’s hands and the patient allows for a greater
precision. Robotic tweezers were specially designed to simulate the movements of
the hands of the surgeon, allowing a dexterity never achieved by laparoscopic sur-
gery. It is not necessary to use force by the surgeon, who controls the robotic arms
with movements of the extremities of the fingers; thus, much less fatigue occurs in
prolonged procedures. The robot helps the trained surgeon to perform surgeries
more safely and accurately.
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viii Introduction
Robotic-assisted prostatectomy has achieved similar oncologic results as those
of open surgery, with the advantage of better preservation of erectile function given
the precise dissection of the pelvic nerves. This surgery is already considered the
standard of excellence in prostate cancer surgery. Robotic gynecological surgery
has seen a significant growth in recent years, also leading to very good results.
In the digestive tract, virtually all surgeries can be performed through the assis-
tance of the robot. In obesity, robotic-assisted surgery allows better access to the
organs, maximized visualization, and high precision in the sutures. In surgery of the
esophagus, it allows a precise, less aggressive anatomical surgery. When operating
the intestine, the robot allows a precise release of the structures, preserving nerves
and vessels that help maintain functions of continence and potency important for
patients. Robotic-assisted surgery greatly helps the surgeon to provide vaster benefit
and safety to patients, especially when there are anastomoses or dissections that
require high precision and privileged visualization; reoperations or revisions are
thus much better accomplished with the aid of the robot. The dual console allows
another surgeon to assist or interfere, facilitating training during the learning curve.
However, perhaps, the most important of this new technology is the new para-
digm introduced in surgery: the existence of a device (called a robot for a lack of a
better title) which allows the use of computer programs for the implementation of
tasks. No other surgical platform, at present, has this feature. The laparoscopic for-
ceps are controlled directly by the hands of the surgeon, and, with the exception of
the energy tweezers, little has changed in the last 20 years.
On the other hand, the incredible advances in diagnostic medicine are well
known, from the introduction of computer programs in imaging and interventionist
equipment; novelties in these areas are announced almost every day.
This same feature is now available to the surgeon. Computer programs, for
example, can be added to allow access to exams during the surgery, identification of
tumor-compromised lymph nodes, and differentiation of vessels, nerves, and other
tissues. Based on this premise, the possibilities of adding new technologies in the
future are nearly endless.
The use of green dye technology is already commercially available, which is
injected through a peripheral vein, and binds to blood proteins. Using a special fluo-
roscopy camera, the surgeon can identify differences between healthy cells and
tumor cells, assess the vascular provision of the parenchyma or viscera, and identify
the biliary route during cholecystectomies. The surgeon can quickly switch from
normal image to the fluoroscopy camera. This allows for a more accurate removal
of tumors, a safer intestinal anastomoses by ensuring the proper irrigation of the
extremities, and an increase in the safety of difficult cholecystectomies, where the
anatomy is imprecise or often anomalous. It has been said that as this technology
allows much better accuracy in identifying hepatic hilum structures and decreases
the risk of inadvertent bile duct injury, it might be considered unethical not to offer
this technology to patients.
The robotics platform has been evolving exponentially. Currently, there is only
one company with equipment approved by the authorities for human use; there is
already a new generation released for use next year, and a new prototype is already
Introduction ix
being tested. When some patents are released, several new equipment already under
test will be available in the market. There will be then a marked decrease in costs,
which is the main obstacle to the generalization of its use.
The robots have come to stay. The possibilities of the interface of computer pro-
grams are almost endless. The costs will decrease in the coming years. The future
has arrived.
Contents
1 Bariatric Surgery: An Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Carlos Eduardo Domene, Paula Volpe, Frederico A. Heitor,
and André Valente Santana
2 Obesity Surgery: Evolution from Laparoscopy to Robotics . . . . . . . . 7
Carlos Eduardo Domene and Paula Volpe
3 The da Vinci Surgical System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Jonathan Douissard, Monika E. Hagen, and P. Morel
4 Overview on Robotic Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Luiz Alfredo Vieira d’Almeida and
Daniella Guimarães Cavalcanti Freitas
5 Training in Robotic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Paula Volpe and Carlos Eduardo Domene
6 Anesthetic Management for Robotic Bariatric Surgery . . . . . . . . . . . 53
Veronica Neves Fialho Queiroz, Rafael Takamitsu Romero,
and Flavio Takaoka
7 Robotic Sleeve Gastrectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Ramon Vilallonga Puy, Roberto Alatorre, and José Manuel Fort
8 Robotic Sleeve Gastrectomy: How I Make It . . . . . . . . . . . . . . . . . . . . 71
Anthony M. Gonzalez and Rodolfo J. Oviedo
9 Robotic Roux-en-Y Gastric Bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Michele Young, Monika E. Hagen, and Keith C. Kim
10 Step-by-Step Surgery: Sleeve Gastrectomy . . . . . . . . . . . . . . . . . . . . . 97
Carlos Eduardo Domene and Paula Volpe
11 Step-by-Step Surgery: Roux-en-Y Gastric Bypass . . . . . . . . . . . . . . . 103
Carlos Eduardo Domene and Paula Volpe
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