Articles written by professionals from The Wellington Hospital for Healthcare Professionals.
Consultant Bariatric and Upper GI Surgeon, Mr Krishna Moorthy discusses the prevalence of robotic surgery in society’s ever-expanding waistline
There is a growing realisation that the UK is in the midst of an obesity epidemic, which is likely to worsen over the coming years. Whilst a controlled diet coupled with exercise is often the prescribed treatment, it is well known that surgery is superior for maintenance of weight loss in patients who are morbidly obese (BMI > 35).
Surgery is not just an effective weight loss tool, but also improves health by reducing the risk of developing obesity-related diseases, such as Type 2 diabetes, high blood pressure, and conditions such as heart attacks and strokes.
The three procedures performed are:
Each surgery procedure has a marked effect on the factors that define the metabolic syndrome, including waist circumference, blood pressure
and cholesterol. In addition to this, many gastric bypass cases have shown to have a profound effect on diabetes, which is independent of
surgery mediated weight loss.
Gastric bypass surgery is increasingly being performed with the help of the da Vinci Si surgical robotic system. The machine consists of a ‘slave’ cart with one camera arm and three robotic arms (Fig 1) that control the robotic instruments, which are inserted through 7 mm robotic ports. The four robotic arms are controlled by the surgeon who sits at the robotic ‘master’ console (Fig 2).
The advantages of the robot in minimally invasive surgery (keyhole surgery) are well established, offering 3D vision and improved precision due to the ability of the robotic system. Not only does the robot remove the surgeon’s natural hand tremor, but it also scales down large movements, making them more precise. In addition to this, the robotic instruments’ ‘wrists’ mean that the surgeon’s hand movements are completely and accurately reproduced by the robotic instruments (Fig 3).
Procedures such as the gastric bypass (Fig 4) are especially suited to robotic surgery as it involves a considerable amount of stitching. Improved visualisation and greater precision means that stitching can be performed more safely and also results in lowering the risk of leakage.
The robot is particularly advantageous when operating on obese patients due to the considerable thickness of the abdominal wall, which can induce fatigue in the surgeon increasing the risk of errors. As the robot eases surgical manoeuvres it may be possible to perform a gastric bypass on patients with a higher BMI (>60). Currently these cases are offered a laparoscopic sleeve gastrectomy. The cosmetic result after a robotic procedure is better than standard laparoscopy, as the incisions are smaller and often placed on the sides, rather than the front of the abdomen, making them less visible.
There are a number of developments planned that will make robotic technology more appealing to patients and improve outcomes. The robotic platform is ideal for the performance of single incision or ‘scarless’ surgery as the robotic instruments will address some of the current problems with single-incision surgery.
The only apparent downside to robotic procedures is that it takes slightly longer compared to standard laparoscopy, but most of this extra time is spent in setting up and can be reduced with experience.
Mr Krishna Moorthy, Bariatric and Upper GI Surgery, robotic surgery, da Vinici Si, gastric banding, gastric bypass, sleeve gastrectomy, metabolic syndrome,
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