Robotic sleeve gastrectomy is a weight loss or bariatric surgical procedure for the treatment of obesity. It is performed with the help of a da Vinci® Robotic Surgical System. In this procedure, about 60-80% of your stomach is removed. This restricts your food intake and helps control and reduce your weight to prevent obesity-related health disorders such as diabetes, hypertension, and sleep apnea.
Robotic sleeve gastrectomy does not involve rerouting of the small intestine so food can move naturally through your stomach into the intestine.
Robotic sleeve gastrectomy helps you lose weight while maintaining the absorption of all the nutrients in your food. Sometimes it is carried out as the first stage of a two-stage operation in extremely obese patients with a BMI of 60 or more. This is done to achieve a considerable amount of weight loss, so it is safer for the patient to undergo a second bariatric surgery if needed.
Indications for Robotic Sleeve Gastrectomy
Robotic sleeve gastrectomy is recommended for extremely obese patients with a high BMI of 40 and above.
Pre-Surgical Preparation for Robotic Sleeve Gastrectomy
Before scheduling robotic sleeve gastrectomy, your doctor examines your health condition and lab reports. You will be required to follow specific instructions related to your diet and lifestyle until your surgery. You should continue to take your medications based on your physician’s instructions. You should quit smoking if you do smoke and perform regular exercise.
Procedure: Robotic Sleeve Gastrectomy
The da Vinci surgical system has three parts which include the surgeon’s console, robotic arms, and a video tower. The surgeon sits at the console and controls the movements of the robotic arms which are attached to the video tower. One robotic arm holds the camera and the other two or three arms control the surgical instruments that are placed in your abdomen through small openings called ports. The camera provides a high-definition, 3D magnified view of the inside of your body for your surgeon to view at the console.
The general steps involved in robotic sleeve gastrectomy include:
- You will be administered general anesthesia.
- You may be placed in the supine or reverse Trendelenburg position depending on your surgeon’s discretion.
- A few small incisions are made in your abdomen through which a tiny camera and the surgical instruments are placed.
- Your surgeon operates the da Vinci System from the console and the robotic arms connected to it bend and rotate the surgical instruments as per the surgeon’s instructions.
- Nearly 75-80% of your stomach is removed under the image guidance received from the attached video camera.
- The remaining part of your stomach is stapled which creates a sleeve shaped like a banana.
- At the end of the procedure, the incisions are sutured.
Postoperative Care for Robotic Sleeve Gastrectomy
Your doctor will prescribe pain-relieving medications to keep you comfortable following the procedure.
- You may be given medications to reduce the amount of gastric acid produced by the stomach.
- You should avoid strenuous exercises and lifting heavy weights until approved by your surgeon.
- For the first month after the procedure, eat only small amounts of soft foods.
- Sip water throughout the day to prevent dehydration.
- Eat a nutritious diet but avoid fatty foods.
Advantages of Robotic Sleeve Gastrectomy
The advantages of robotic sleeve gastrectomy surgery include:
- It provides surgeons with much improved visualization
- Greater accuracy to perform the surgery
- It is performed through smaller incisions and thus it less invasive compared to traditional open surgeries
- No intestinal bypass and its associated risks
- Leaves a smaller scar
- Less pain
- Less blood loss
- Lower risk of infection
- Quicker recovery
- Less operative time than bypass surgeries
- Shorter hospital stay
- You will feel hungry less often as the reduced stomach volume increases the feeling of fullness
- Stomach functions normally allowing most foods to be eaten, just in smaller amounts
- Stomach portion that produces a hunger-stimulating hormone (ghrelin) is removed
- Simpler procedure than gastric bypass
- Safer first stage procedure of two-stage surgery for super morbidly obese
Most patients lose 60 to 80% of excess body weight within one to two years after the procedure.
Disadvantages of Robotic Sleeve Gastrectomy
The disadvantages of robotic sleeve gastrectomy may include:
- Dilation of the sleeve which hampers weight loss
- Possibility of inadequate weight loss or weight regain compared to intestinal bypass surgeries
Risks & Complications of Robotic Sleeve Gastrectomy
As with any surgery, robotic sleeve gastrectomy may also have certain risks and complications. These include:
- Complications from anesthesia
- Blood clot in the deep leg veins called deep vein thrombosis
- Leakage of digestive contents from the staple line can lead to serious infection
- Blood loss requiring transfusion
- Heart attack, stroke, kidney failure, pneumonia, bladder injury
- Damage to surrounding tissues