The laparoscopic gastric bypass surgery (a Roux-en-Y procedure) is often considered the most challenging minimally invasive procedure in general surgery, requiring a learning curve of 75 to100 cases for even experienced surgeons to achieve the highest level of proficiency, according to background information in the article. Although robotic surgical techniques have been developed to assist laparoscopic gastric bypass surgery, the complex geometry of the surgery has required repositioning of the robot, complicating its use.

Catherine J. Mohr, M.S.M.E., of the Stanford School of Medicine and colleagues report the first ten patients to undergo a totally robotic laparoscopic Roux-en-Y gastric bypass surgery using a technique developed to minimise robot repositioning. The results were compared with a sample of ten patients who had undergone standard laparoscopic Roux-en-Y gastric bypass surgery.

The researchers compared surgical times as well as the ratio of the procedure time to the patient’s BMI. The number and severity of complication were comparable, the researchers found. “The median length of time to complete the procedure was significantly shorter with the robot (169 vs. 208 minutes),” the authors report. “In addition, the ratio of procedure time to BMI was considerably lower with the robot (median, 3.8 vs. 5.0 minutes per BMI for the laparoscopic cases).

Moreover, the rate at which the operative times improved indicate that the learning curve for the robotic procedure is considerably shorter. We found that the mean minutes per BMI of our second five robotic procedures was 3.45 minutes, whereas the laparoscopic data for our senior attending surgeon did not attain a comparable five-case mean of the metric until case 42. In addition, when the data from a bariatric fellow from the same institution were compared, that surgeon did not match the metric until surgical case 85.”; Source: American Medical Association (AMA)