Recently I was invited to Illinois Association of Bariatric Surgeons to give a talk on Robotic Sleeve Gastrectomy, while the other two speakers spoke about laparoscopic and single incision approaches to sleeve.  The American Society for Metabolic and Bariatric Surgeons conference this June in Orlando, FL had a Great Debate in Bariatric Surgery session, a debate on ‘Which approach is best for sleeve Gastrectomy?  SILS vs. Laparoscopic vs. Robotic among Drs. Teixiera, Rosenthal and Wilson.  It seems the entire surgical community is evaluating which approach will out do the others.

As a matter of fact, the June edition of General Surgery News has dedicated page 17 to different expert bariatric surgeon’s on the spot gut reaction on Single-port access, Gastric plication, NOTES, Robotic bariatric surgery and Needlescopic surgery.  Of the twelve surgeons that were featured none of them had an encouraging comment on robotic bariatric surgery expect for Dr. Pories, yet these are some of the surgeons that have in the past or currently advancing the limits of bariatric surgery.

While I am not going to get as personal as Dr. Mason’s comment on Robotic bariatric surgery is for ‘Obese bariatric surgeons’, there are certain comments I like to make professionally.  First, the discussion could be less biased if it were among a group of surgeons that has personally utilized all these approaches beyond learning curve to assess the pros and cons of each technique and outcomes.  Until such time we may have to be tolerant to other approaches.  Secondly, whether the technique can be easily reproducible by future generations and if it can show a benefit to patients and surgeons.  Third, if this technique has a potential to form a platform from which other advances in medicine and surgery can be expected.

While I am not going to write down all the advantages and disadvantages of each approach, Laparoscopy has better patient outcomes then open surgery but it does not augment the surgeon’s full potential.  Single incision might have a better cosmesis then open surgery and potentially over multi trocar laparoscopy but it is restrictive in its reproducibility, requires advanced laparoscopic skills, suboptimal, lacks stability and first assistance for retraction, exposure with parallel working environment.  Its application to complex cases is still open for investigation.  Robotic surgery not only augments the surgeon’s full potential in routine cases but can adjunct with different options when a so called routine case becomes a complex case.  It is reproducible, provides stable platform where future advances in medicine and surgery that are practically applicable are already evolving.

While I agree with Drs. Jones, Schweitzer and Zundel that the robotic technology is  very expensive but my own on the spot gut reaction to Dr. Gagner comment about robotic bariatric surgery ‘not useful for patients with present technology’, would single incision robotic surgery do?  To Drs. Cohen, Pomp and Shikora’s comments of ‘not useful so far’ reevaluate its benefits in your practices.  For Dr. Nguyen comment ‘technology before its time’, then exploit the technology.  To Dr. Mason’s comment that it is for ‘obese bariatric surgeons’, robotic technology has assisted surgeons in making a easy transition from open surgery to minimally invasive robotic approach rather than minimally invasive laparoscopic or single incision approach instead of subjecting the patient to the morbidity of open surgery because of surgeon’s skills level.

Best Regards,

Subhashini Ayloo  MD. FACS.


One Response to “Making a Case for Robotic Bariatric Surgery”

  1. Troy Houseworth Says:

    I was also taken back by the responses from the current leaders in the field of bariatric surgery about robotics and commend you on your comments which are very well stated. Their comments remind me of those made by the leaders in open surgery about laparoscopy in the late 1980s. It is also surprising how surgeons with little or no experience with a new technique are so willing to take a position on its effectiveness. Thanks for your comments. We should talk sometime.
    Troy Houseworth M.D. FACS

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