Totally Robotic Laparoscopic Roux-en-Y Gastric Bypass: Results from 75 patients

Background: A technique for Totally Robotic Laparoscopic Roux-en-y Gastric Bypass (TRLRYGBP) has been reported previously. In this paper, we report our experience with our first 75 TRLRYGBP operations, including the training of three laparoscopic fellows. We describe changes in technique that have evolved with more experience, lessons learned, and the results from a larger series. Methods: A retrospective review was conducted of the first 75 TRLRYGBP procedures performed at our institution using the da Vinci surgical robot. We recorded demographics including patient age, gender, preoperative BMI, and numbers of NIH-defined co-morbidities. Data were collected on operative time, length of stay, complications, and postoperative weight loss. Results were compared between the three fellows to examine learning curves. Results: The average patient age was 44 years (23-61), average BMI was 46.1 kg/m(2) (34.3-65.5), and the median number of NIH defined co-morbidities was 1 (0-3). Median operative time was 140 minutes (80-312) with mean operative time per BMI of 3.1 minutes (1.6-5.7). Excess weight loss was 48% at 3 months, 64% at 6 months, and 82% at 1 year. The overall complication rate was 22.6% (5.3% intraoperative, 8.0% major, and 9.3% minor including a 2.9% stricture rate and 0% leak rate). Each fellow demonstrated a learning curve of 10-15 cases. Conclusion: The authors' continued experience with the TRLRYGBP has confirmed our early results that the use of the da Vinci robot for laparoscopic gastric bypass is a superior alternative to the standard laparoscopic RYGBP, and that the learning curve is significantly faster.