Robotic Assisted Bariatric Surgeries

What is Robotic Assisted Bariatric Surgery?

Bariatric surgery, also known as weight loss surgery, helps to induce weight loss in obese individuals. It can be recommended by your doctor as a weight-loss treatment if other methods of weight loss have failed.

Robotic assisted bariatric surgery is a form of advanced weight-loss surgery that applies robotic technology to help improve the precision, control, and visualization of the surgeon. The technique makes use of a robotic system that aids the surgeon in making subtle movements with precision.

This technique involves minimum cuts, so healing becomes faster, with minimal pain post-surgery. It is best for those whose BMI stands at more than 40 because in these cases the conventional laparoscopic procedure is more complex and challenging to perform. It is essential to keep in mind that in robot assisted bariatric surgery, the surgeon is in control of the complete procedure; the robot cannot make up for any lack of skill in the surgeon.

Who Needs Robotic Assisted Bariatric Surgery?

Robotic assisted bariatric surgery is for individuals who have severe obesity and have failed to lose weight with non-surgical interventions, such as diet, exercise, and medication. It is suitable for patients who may have more complex health needs or anatomical challenges. Thus, patients who may be considered for this procedure include the following:

• Patients with a High BMI:  The robotic assisted bariatric surgery is designed for patients with a BMI of 40 or more, falling under the category of severe obesity, or a BMI of 35-39.9 with serious health conditions due to obesity. Individuals with a higher BMI usually have more visceral fat and tissue that is thicker, and this makes laparoscopic surgery more difficult. The robotic assisted surgery enables better access and precision in hard-to-reach abdominal areas.
• Patients with Obesity-Related Health Conditions (Comorbidities): Obesity-related conditions include but are not limited to:

• Type 2 diabetes
• Hypertension
• Obstructive sleep apnea
• Heart disease
• Non-alcoholic fatty liver disease (NAFLD)
• Back or joint pain or osteoarthritis from too much weight on joints

All of these conditions can worsen with obesity, and bariatric surgery can really improve or even cure all these comorbidities. Robotic assisted surgery, with its outstanding precision, reduces the risk of complications, making it a safer option for patients with comorbidities.

• Patients Who Failed Non-Surgical Weight-Loss Methods: Patients who have attempted but failed to lose weight with approaches such as:

• Diet and exercise programs
• Weight-loss medications or weight-management counseling
• Behavioral or lifestyle changes

For those who have failed or not been able to reach durable success with conventional weight loss schemes, robotic assisted bariatric surgery offers a more effective and long-lasting alternative. It results in substantial weight loss, particularly when combined with lifestyle changes.

What are the Benefits of Robotic Assisted Bariatric Surgery?

Robotic assisted bariatric surgery presents many benefits to patients and surgeons, particularly when the procedure is complex. The main advantages of robotic assisted bariatric surgery are as follows:

• Enhanced Precision and Dexterity: Robotic assisted surgery provides more detailed precision than the traditional laparoscopic surgery. The robotic system includes "wristed" instruments that can reach several directions, much more than human hands can. This enables the surgeons to execute more delicate, accurate movements, even in difficult-to-reach regions of the abdomen.
• 3D, High-Definition Visualization: Unlike the 2D view provided in laparoscopic surgery, robotic assisted surgery offers a magnified, high-definition, three-dimensional (3D) view of the surgical site. It allows surgeons to see even the smallest details of the stomach, intestines, and other tissues due to depth perception.
• More Access to Hard-to-Reach Areas: Through robotic assisted surgery, the surgeon can access even the most confined spaces of the abdominal cavity.
• Less Fatigue and More Surgeon Comfort: Traditional laparoscopic surgery is usually performed by a surgeon who has to stand and work with long-handled medical instruments. However, in robot assisted surgery, the movements are controlled through hand-operated joysticks and foot pedals as the surgeon sits at a console.
• Less Invasive Bariatric Surgery: Unlike open surgery, robot assisted weight loss surgery requires a few small incisions only. The smaller incision will lead to less pain with minimal scarring and faster healing.

What are the Tests Conducted Before Robotic Assisted Bariatric Surgery?

Some of the tests that are conducted before robotic assisted bariatric surgery include the following:

• Detailed medical assessment: A check-up to ensure that the individual's general well-being is free of any undiagnosed conditions that may likely influence the surgery.
• Blood Tests:  Tests that check and review the level of activities performed by the kidneys, and livers, and whether or not there is an increased blood sugar level, infected cells, or deficiencies causing discomfort in the surgery.
• ECG: ECG is to study the electrical activity of the heart, to identify possible heart problems that might have an impact on the surgery.
• Imaging and Diagnostic Tests: Abdominal ultrasounds or CT scans may be conducted to analyze the stomach, liver, and other adjacent organs for any kind of abnormalities.
• Chest X-ray: A chest X-ray is done to determine how the lungs are working and if there are lung issues that could complicate surgery or recovery.
• Upper Endoscopy: An endoscopy may be done to determine if there are problems, such as acid reflux (GERD), ulcers, or other diseases that can affect surgery.

How to Prepare for Robotic Assisted Bariatric Surgery?

Preparing for robotic assisted bariatric surgery is crucial to ensure a smooth procedure and recovery. Some of the steps to follow include:

• Your healthcare provider will inspect your medical history and conduct a physical assessment to identify any problems that may affect the surgery.
• You will be tested for blood work, imaging, such as X-rays or CT scans, and heart function tests to rule out complications that may arise.
• Inform your doctor of any allergies to medications, anesthesia, or latex so that you can be prepared to avoid allergic reactions in the operating room.
• Inform your surgeon about all medications, supplements, or herbal products that you are currently taking. You may be recommended to stop certain medications, like blood thinners, aspirin, anti-inflammatories, and certain supplements, at least 1 to 2 weeks prior to surgery to avoid complications.
• Avoid alcohol and tobacco for several days before and several weeks following surgery to improve healing and reduce complications.
• Do not eat or drink anything for at least 8 hours before surgery to avoid complications from anesthesia.
• Make sure you have a family member, friend, or driver to take you home after the procedure because you cannot drive yourself.

How is Robotic Assisted Bariatric Surgery Performed?

Robotic assisted bariatric surgery is a minimally invasive technique wherein a surgeon uses a robotic system to improve precision, control, and visualization. The surgeon is always in full control of the procedure, and the robot serves merely as an advanced surgical tool, not as an independent operator.

The process starts with the patient undergoing general anesthesia. Small incisions are made in the abdomen through which trocars are placed to allow entry for robotic arms, instruments, and a high-definition 3D camera.

Once the trocars are set, the robotic system docks and its arms are attached to the access points. Then, the surgeon moves into a console station where he/she controls the robotic arms with hand and foot controls.

The robotic system reflects the accurate movements of the surgeon with better dexterity, stability, and precision. It accommodates micro-movements that cannot be done so well by human hands, much more in dense abdominal tissues or even in tight areas with limited reach. During the entire procedure, the surgeon is provided with a 3D, high-definition view of the internal organs, thereby ensuring better visibility and control.

The robotic arms will then execute the necessary surgical steps, which may include the resizing of the stomach, such as in gastric sleeve surgery, or rerouting of the intestines, as in gastric bypass surgery. After the completion of the procedure, the robotic instruments are removed, and the small incisions are closed.

What are the Post-Operative Guidelines to follow after Robotic assisted bariatric surgery?

Some of the post-operative guidelines to follow after robotic assisted bariatric surgery include:

• Hospital Stay: It is essential to stay in the hospital for 2-3 days. Pain medication and antacids will be administered to decrease pain and stomach acid secretion.
• Walking: Walking should be initiated immediately after the surgery to prevent clotting, improve blood circulation, and prevent respiratory complications and bed sores.
• Adhere to a specific diet: Stick to a liquid diet for the first 2 weeks followed by pureed, soft, and gradually to solid foods as prescribed by your surgeon or dietitian.
• Avoid Smoking and Alcohol: Avoid smoking and alcohol because these substances could delay the healing process and cause complications.
• Avoid Strenuous Activities: Avoid performing strenuous activities and heavy lifting more than 5 pounds.
• Do Not Drive Until Total Healing: You should avoid driving until you get fit and get approval from your doctor.
• Hydration: Drink plenty of fluids daily to avoid dehydration, which is important for proper healing and overall well-being.