Robotics in Laparoscopic Gastric Bypass

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Robotics in Laparoscopic Gastric Bypass

• Westchester Medical Center
• New York Medical College

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Patient Demographics

• Number of cases 50
• Average age (years) 42.5
• Gender (male/female) 6/44
• Average weight (kgs) 146.2
• Average BMI (kg/m2) 52.8
• Average LOS (days) 4.6

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Comorbid Conditions

• Asthma 7
• Sleep apnea 12
• High cholesterol 10
• Arthritis 12
• Diabetes mellitus 13
• Hypertension 18
• Gastroesophageal reflux 5

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Operating Times

• Laparoscopic portion (min) 149
• Robot setup time (min) 14
• Robotic portion (min) 62
• Robot takedown time (min) 7

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Robot Setup Time
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Robotic Work Time
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Laparoscopic Time vs BMI
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Robotic Time vs BMI
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Robotic Gastrojejunostomy

• Better control of stoma size
• Improved precision of suturing and location on
  pouch
• More readily reproducible between surgeons
• Facilitates anastomosis in patients with
  unfavorable anatomy
• Postoperative complications
• No strictures
• No anastomotic leaks

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Future Directions

• To incorporate surgical robot into entire
  procedure
• Follow post-op weight Loss and complications vs.
  none robotic cases

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Limitation of Minimally Invasive Surgery

• Limited degrees of motion
• Unstable camera platform
• Hand movement is counter-intuitive
• Adverse ergonomics impaired dexterity
• 2-dimensional video Imaging
• Degradation of sense of touch

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Historical

• 1980s NASA
• 1990s Pentagon (DARPA)
• Bring the surgeon to the wounded soldier
• Medical Forward advanced surgical treatment
  (MEDFAST)

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• Surgeon sits at console away from patient
• Better control, finer complex movements
• Less tissue trauma

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Robotic Surgery
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Robotic Surgery

• Console front view

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Robotic Surgery

• Console interfaces

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Robotic Surgery

• Head Rest

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Robotic Surgery

• Surgical cart with instruments

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Robotic Surgery

• Improved precision
• Motion scaling 11, 31, 51
• Tremor elimination
• Forearm support
• 3-D magnified field
• Greater degrees of freedom ( adds pitch, yaw, and
  rotation)

Masters
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• Robotic movements
• Simultaneous
• Fluid
• Direct and intuitive
• ambidextrous

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Robotic Surgery

• Vision
• Magnification X 10
• Xenon light source
• Under surgeons control
• 3 D vision

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Robotic Surgery

• Endoscope ends

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Robotic Surgery - Instruments