Minimally Invasive Robotic Weight Loss Surgery
Why is it innovative?
In the not too distant past, many weight loss (bariatric) surgeries were done laparoscopically, with the surgeon operating through multiple small incisions using rigid tools. Bariatric surgeons at NewYork-Presbyterian/Weill Cornell Medical Center and NewYork-Presbyterian/Columbia University Irving Medical Center are now performing virtually all weight loss surgeries, such as sleeve gastrectomy and gastric bypass, with robotic surgical assistance—the latest evolution in weight loss surgical technique. Like laparoscopic surgery, robotic surgery is a minimally invasive procedure performed through small incisions in the abdomen. But robotic surgery is more exact, due to a greater range of motion and stability and a vastly improved view of the surgical field (the area being operated on). It may also make minimally invasive bariatric surgery an option for very morbidly obese patients and those with scar tissue due to prior operations who were not previously candidates for this approach.
How you benefit
People who have robotic bariatric surgery may benefit from:
- Small incisions with minimized scarring
- Better incision closure and stapling due to the steadiness of the robotic system and advances in instrumentation
- An operation that does not require skilled assistance in addition to the surgeon
- Less pain and discomfort after surgery
- Lower rate of postsurgical complications, such as leaks, and therefore a reduced risk of needing revisional surgery to correct such problems
- A quick recovery and return to normal activities
How does it work?
It's important to note that the robot does not perform the surgery; rather, the robotic system is a tool the surgeon uses to complete the operation. Here's how it works:
- The surgical robot's four arms are positioned where needed in the patient's abdomen. Newer versions of the surgical robot are sleeker than prior models, with thinner arms that make positioning easier in very obese patients.
- The surgeon sits comfortably at the robotic surgery console and is able to control the system's instruments from there.
- Looking into the console, the surgeon obtains an exceptionally clear and magnified view of the interior of the patient's abdomen — 4-10X magnification, versus 2X for laparoscopy — with enhanced 3D visualization.
- The dexterity of the robotic tools enables the surgeon to perform the procedure with greater range of motion than that afforded by conventional inflexible laparoscopic tools.
- The surgeon completes the procedure and closes the patient's incisions.
Is it for me?
Robotic bariatric surgery may be an option for very obese people who will be having:
- Sleeve gastrectomy, where the surgeon removes up to 75 percent of the stomach, reducing it to the shape of a banana or "sleeve" and restricting the amount of food you can eat.
- Gastric bypass, where the surgeon creates a small pouch in the top of your stomach that forms a “new stomach,” limiting the amount of food you can eat during a meal and helping you feel fuller sooner. The surgeon then creates a small opening, or stoma, in the pouch and attaches that opening to a section of your small intestine. The reconnected intestine causes food to bypass part of the intestine, so some of the nutrients and calories will not be absorbed. The altered anatomy also leads to changes in your hormones which further helps you to feel full sooner.
- Revisional surgery, the need for another bariatric procedure due to failure of the first operation (leading to weight gain) or complications such as leaks and narrowed areas (strictures).
Because robotic surgery it so precise, it can take a bit longer. It may not be recommended for very ill or compromised patients who need a weight loss procedure to be completed faster.
What does the future hold?
- NewYork-Presbyterian's surgeons have been refining the use of robotic bariatric surgery to perform "duodenal switch," a complex procedure which promotes weight loss by combining sleeve gastrectomy with intestinal bypass. The goal is to obtain FDA approval for this procedure, based on promising outcomes data from within the institution.
- The utilization of robotic platforms is expected to increase. There are many companies working on making more, newer, and better robots for surgical use. We are just at the beginning of the innovation curve and haven’t yet imagined all the possible uses.
- As time goes by, better patient outcomes may be achieved as surgeons become more proficient in the technique and the stability, precision, and visualization of the procedure continue to improve.