B. Snyder

A new post has been published on Clinical Robotics.

S. Ayloo, R. Kakarla, G. Contino, M. El Zaeedi, PC. Giulianotti

Introduction: Adjustable gastric banding (LAGB) is an effective surgical procedure for morbid obesity. Yet revisional bariatric procedure has been on rise with patients who has failed to achieve successful weight loss with initial surgery. We present a technical video of conversion of adjustable gastric banding to roux-en-y gastric bypass (RYGBP) with robotic approach with single docking. Methods A 46-year old woman who underwent a LAGB 5 years ago with several adjustments and current BMI 44, failed in achieving adequate weight loss presented for revisional bariatric surgery. The patient choose to proceed with RYGBP. Results The procedure began with a diagnostic laparoscopy. Extensive adhesiolysis was performed laparoscopically. The daVinci system was docked cranially and proceeded with releasing the adjustable gastric band. A Gastric pouch was created using endo GIA staplers. A double layer hand sewn gastro-jejunal anastomosis was created in omega 30 cm from Treitz ligament. Then a latero-lateral jejuno-jejunostomy was done with stapler and hand sewn suture. The afferent loop was then transected creating a Roux-en-Y. An endoscopic evaluation of the stomach and air leak test was performed, confirming integrity of the gastro-jejunal anastomosis. There were no intra- or post-operative complications. Conclusions The conversion of gastric band to RYGBP is a valid therapeutic option for patients with no substantial weight loss from their initial surgery. Revisional bariatric surgery can be performed safely and the robotic technology is a useful option in redo surgery, allowing for accurate, precise, fine dissection, with the advantage of a 4th arm assisting in retraction and exposure in a distorted anatomy.

A new post has been published on Clinical Robotics.

S. Ayloo, F. Gheza, S. D’Ugo, L. Milone, PC. Giulianotti

Introduction: Solid dysphagia could be a late complication of gastric band, but rarely is associate to a massive passage of the gastric fundus through the band with an associated migration of the gastroesophageal junction in the thorax after more than 5 years. We present herein a video of a robotic-assisted hiatal hernia repair in a patient with an adjustable gastric band though which stomach fundus herniated. Methods A 65-year old obese female, BMI 35, underwent 5 years ago laparoscopic adjustable gastric band positioning. 7 months before referring to us she started to complain severe GERD and dysphagia for solids. A chest X-ray and a CT scan showed a herniation of about 5 cm of the gastroesophageal junction in the thorax. Patient was elected for Robotic approach to correct the herniation trying to save the band. Results A diagnostic laparoscopy was performed, reveling a great number of adhesion in the gastrophrenic ligament. It was very clear that the band was migrated up towards the hiatus and she has a hiatal hernia. A careful dissection was done in delineating both pillars of the crura on the left, and then entered the gastrohepatic ligament on the right, and then complete mobilization was performed at the GE-junction and the esophagus. Circumferential dissection at the distal esophagus was done to mobilize and reduce that portion of the stomach that has herniated into her chest and pulled down. Once this was done, the crura was approximated with 2-0 Prolene using pledgets, which was snug but not tight, and the band was left alone. The operative time was 90 minutes. There were no operative complications. Patient was discharged on postoperative day 2. Conclusions The robotic approach allows complex second-look intervention where fine dissection is required, in this case reparing the herniation avoiding the band removal.

A new post has been published on Clinical Robotics.

S. Ayloo, F. Gheza, D. Calatayud, PC. Giulianotti

Introduction: The Gastric Banding is the most diffused procedure for morbid obese patients. Sometimes the weight loss is not appropriate, requiring a new therapeutic. We present here a video using the robotic assisted laparoscopic approach to convert a gastric banding to Sleeve gastrectomy. Methods This 43-year old woman underwent laparoscopic adjustable gastric banding five years ago with 10 different adjustments without any benefits and a current BMI of 44. We plan to convert the procedure in a fully robotic sleeve gastrectomy. Results The pneumoperitoneum was achieved and a diagnostic laparoscopy was performed. The procedure started dissecting the scar tissue around the gastric band, which was then cut and removed from the abdomen. A vertical tubular gastrectomy was performed using a 38 French Bougie as a calibrator with multiple loads of the Endo-GIA stapler with GORE? reinforcement. Haemostasis was checked and an air leak test performed. The operative time was 220 minutes and estimated blood less than 20 cc. There was no intraoperative complication and the patient was discharged on post operative day 2. Conclusions The conversion of a gastric banding into sleeve gastrectomy is a valid therapeutic option in patient with no substantial weight loss although more data are needed to draw definitive conclusions. The robot is a useful option in redo surgery, allowing fine dissection.

A new post has been published on Clinical Robotics.