The Economy of Motion of the Totally Robotic Gastric Bypass: Technique, Learning Curve, and Outcomes of a Fellowship-Trained, Robotic Bariatric Surgeon

We present our technique for a totally robot-assisted laparoscopic Roux-en-Y gastric bypass. Moreover, data are presented in relation to a single-surgeon experience with use of the robotic platform in bariatric surgery. We reviewed a single surgeon's console and room time from 2009 to 2013 for all robot-assisted Roux-en-Y gastric bypasses (RARYGBs). Revision operations were excluded. There were in total 168 robotic bariatric operations in this time frame. The number of cases performed each year and the cumulative number of each operation were considered as well. The change in console time as related to the number of cases and the change in room time as related to the console time and number of cases were investigated. Complications during this time and their frequency were noted and described. The console time for RARYGB ranged from 131 +/- 46 minutes in 2010 to 94 +/- 29 minutes in 2013 (P<.05). There were in total 22 complications, for an overall complication rate of 13.1%: four anastomotic strictures (2.4%), seven marginal ulcerations (4.2%), two gastrointestinal bleeds (1.2%), five internal hernias (3.0%), two abdominal pains requiring diagnostic laparoscopy (1.2%), and two gastrointestinal leaks (1.2%). There were no deaths. In this series, the console surgeon performed 168 RARYGBs and had a leak rate of 1.2% and a mortality of 0% within the first 66 cases and a 0% leak rate over the next 102 cases. Thus, we believe that the robot has a decreased caseload requirement to reach proficiency with comparable outcomes versus both the hybrid and purely laparoscopic approaches.