Robot-Assisted One Anastomosis Gastric Bypass: 10 Steps Standardized Technique
Author:Sofia Daniela Reis Sofia Daniela Reis, MD Celso Nabais, António Albuquerque, Sara Vaz Rodrigues, Nuno Borges, Anabela Guerra, João Pereira and Leonor Manaças
Step into the world of advanced surgical procedures with our comprehensive video on Robot-Assisted One Anastomosis Gastric Bypass. This meticulously edited video guides you through each of the 10 standardized steps employed in our high-volume surgical unit, showcasing a state-of-the-art approach to gastric bypass surgery. The steps are:
This video provides an invaluable resource for surgeons, medical professionals, and enthusiasts interested in the intricacies of Robot-Assisted One Anastomosis Gastric Bypass. Our standardized technique aims to contribute to the advancement of knowledge and skills in the field of bariatric surgery. Embrace innovation and precision in every step of this transformative surgical journey.
Obesity constitutes a severe global issue, and bariatric surgery remains the most effective treatment for this condition.
We present a video of a standardized 10-step technique for performing a Robot-Assisted One Anastomosis Gastric Bypass.
While the laparoscopic approach for bariatric surgery remains the established gold standard, robotic surgery has gained increasing popularity, particularly in the management of super and super-super obesity patients.
In the face of the current obesity pandemic, characterized by an alarming rise in global obesity rates, the quest for effective and sustainable solutions has never been more pressing. Obesity is not only a major public health concern due to its association with various comorbidities, but it also poses a significant economic burden on healthcare systems worldwide. Bariatric surgery has emerged as a transformative approach, not only for achieving substantial weight loss but also for providing remarkable remission of obesity-related diseases.
This video demonstrates a standardized 10-step technique for performing a Robot-Assisted One Anastomosis Gastric Bypass. It is edited in a step-by-step format to showcase this surgical technique's feasibility, safety, and potential benefits in enhancing patient outcomes.
We present a case of a 50-year-old woman with super obesity (BMI 51.14) and multiple comorbidities, including type 2 diabetes (under oral antidiabetic treatment) and arterial hypertension. Preoperative assessments revealed hepatic steatosis on abdominal ultrasound and moderate chronic gastritis on upper GI endoscopy biopsies. The biopsies also showed the presence of helicobacter pylori, which was successfully eradicated. After a multidisciplinary evaluation, the patient underwent a robotically assisted one anastomosis gastric bypass with a 200cm biliopancreatic limb. The surgery was uneventful.
In the first postoperative month, we already observed significant benefits: a substantial weight loss of 17.2 kg, resulting in a BMI of 41.91; improvement of comorbidities with remission of type 2 diabetes and reduced medical therapy for hypertension.
While the laparoscopic approach for bariatric surgery remains the established gold standard, robotic surgery has gained increasing popularity, particularly in the management of super and super-super obesity patients. This technique facilitates the execution of the anastomosis, a critical aspect of bariatric procedures while providing enhanced exposure in challenging surgical fields.
There are no conflicts to declare.
Dr. Hélder Além
Felsenreich DM, Bichler C, Langer FB, et al. Surgical Technique for One-Anastomosis Gastric Bypass. Surg Technol Int. 2020;37:57-61.
https://pubmed.ncbi.nlm.nih.gov/33180956/
Carbajo MA, Luque-de-León E, Jiménez JM, Ortiz-de-Solórzano J, Pérez-Miranda M, Castro-Alija MJ. Laparoscopic One-Anastomosis Gastric Bypass: Technique, Results, and Long-Term Follow-Up in 1200 Patients. Obes Surg. 2017;27(5):1153-1167. doi:10.1007/s11695-016-2428-1
https://pubmed.ncbi.nlm.nih.gov/27783366/
As technique and technology have evolved in the modern age, surgical emphasis has shifted steadily towards minimally invasive alternatives. In colon surgery, laparoscopy has been shown to improve multiple outcome metrics, including reductions in post-operative morbidity, pain, and hospital length of stay, while maintaining surgical success rates. Unfortunately, despite the minimally invasive approach, elective laparoscopic sigmoidectomy typically requires an abdominal wall extraction site, leaving a large incision in addition to the laparoscopic port sites. It also utilizes three different types of intestinal staplers, leading to an anastomosis that may have multiple intersecting staple lines, thereby potentially influencing the anastomotic integrity, as well as increasing procedural costs substantially.
We present a case of a totally robotic sigmoidectomy utilizing a single stapler technique and natural orifice specimen extraction in a patient with multiple, severe, recurrent episodes of sigmoid diverticulitis over a 2-year period.
Disclosure/ Conflict of interest: The authors whose names are listed above certify that they have NO affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers ’bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
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