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Live Event Content
Guillermo Ares, MD and Mark Wulkan, MD - 2024 Pediatric Bariatric Surgery Update Course
With Dr. Mark Wulkan & Dr. Guillermo Ares
Part of
Obesity 30 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Robotic platforms provide markedly superior 3D stereoscopic visualization compared to laparoscopic cameras.
Wristed robotic instruments improve dexterity and enable more complex intraoperative procedures including intracorporeal suturing and complex anastomoses.
In robotic surgery, the surgeon assists themselves and controls the entire operation including dissection and exposure, displacing one staffing member.
Controlling the operation from all angles is especially important in revisional bariatric surgery where retraction matters significantly.
The Da Vinci XI platform is what should be used for robotic bariatric surgery; other platforms are outdated and don't provide the same support.
Development of a robotic stapler was the last piece to equalize laparoscopic versus robotic surgery, occurring in the later half of the last decade.
Obesity hurts kidneys and obesity hurts transplanted kidneys.
Robotic technology is still in its infancy.
There has been one robotic vendor for the last 20 years; now there will be at least 2 other robots coming on the market this year, which should create competition and improve instruments.
Laparoscopic sleeve gastrectomy can be performed with a medical student assistant without taking excessive time.
Until the cost of the robot decreases, it will not be widely adopted.
Ares's first robotic case to second robotic case, OR time cut in half, and continued to decrease from there.
Turnover time between robotic cases is similar to laparoscopic when there is a dedicated robotic team; without one, turnaround time is palpably longer.
Wristed instruments and 3D vision are better than straight instruments and 2D vision.
Once a surgeon has done robotic surgery, they want to only do robotic surgery because it is so much better than laparoscopic.
Studies using EMG, motion tracking, and questionnaires show statistically significant increased muscle strain, postoperative pain, and overuse of muscles in surgeons performing laparoscopic versus robotic surgery.
Statistically significant change in surgeon irritability is quoted after robotic versus laparoscopic surgery.
Studies show decreased conversion to open in robotic revisional bariatric surgery compared to laparoscopic.
More advanced or complicated revisional surgeries are being performed on robotic platforms compared to laparoscopic ones, suggesting intuitive selection of robotics for harder cases.
A retrospective study from 2015 to 2020 showed that over time, more robotic cases were performed, complication rates decreased, OR times decreased significantly (in some centers to no difference versus laparoscopic), sicker patients were operated robotically, and more robotic cases were revisional compared to laparoscopic.
Simultaneous robotic sleeve gastrectomy and kidney transplants are now being performed on morbidly obese patients, with longer operative times but no increased complications or blood loss, and good 1-year kidney function with significant weight reduction.
Large comparative studies show really no difference in outcomes between robotic and laparoscopic bariatric surgery.
A large study shows there may be a little bit of increase in infectious complications with robotic surgery.
In the MBSAQIP database study of almost 800,000 patients, robotic Roux-en-Y had slightly lower infectious complications, but with sleeve it was higher, and robotic surgeries had higher 30-day readmission and reoperative rates.
In centers doing robotic bariatric surgery repeatedly with a dedicated OR robotic team, operative times approach or equal laparoscopic surgery times.