Technical aspects and standardization of the totally robotic Roux-en-Y gastric bypass. Results of a single surgeon experience with a 5-year follow-up

Introduction The use of robotics in bariatric surgery is increasing worldwide, with as main objective reducing complications and optimising surgical outcome. This study presents the results of a single surgeon 8-year experience with a totally robotic Roux-en-Y gastric bypass (RYGB). Methods A total of 183 consecutive patients underwent a robotic bariatric procedure. A retrospective analysis was performed of all patient files to obtain patient characteristics, weight loss results and per- and postoperative morbidity. For long-term follow-up all patients were contacted one by one. Results In 155/183 patients, a primary RYGB was performed, 23 procedures were revisional cases and in 5 other procedures were performed. Mean initial weight was 112.07 (+/- 20.5) kg, mean start BMI was 40.8 (+/- 5.36) kg/m(2). There were no conversions and no major intraoperative complications. In the early postoperative period we note two revisions; one postoperative bleeding and one missed iatrogenic enterotomy. Mean length of stay in the hospital was 3.50 (+/- 1.20) days. After a mean follow-up of 62.06 (+/- 32.76) months, mean BMI was 28.07 (+/- 4.88) kg/m(2) with an % excess body mass index loss of 84.02 (+/- 31.64) %. Patient satisfaction was high, with 95.1% of the patients being happy. The main complaint in the remaining patients was weight regain. Conclusion The robotic RYGB is a safe and reproducible approach to treat morbid obesity. A secure hand-sewn gastrojejunal anastomosis, quick recovery and better ergonomics are the main advantages of this technique.