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Live Event Content
Guillermo Ares, MD and Mark Wulkan, MD - 2024 Pediatric Bariatric Surgery Update Course
With Dr. Mark Wulkan & Dr. Guillermo Ares · hosted by Dr. Em Gootee
Part of
Obesity 25 items
Chapter 1 of 5 · Fundamentals
Introductions
Introduction and speaker setup
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Robotic platforms provide markedly superior 3D stereoscopic vision compared to laparoscopic cameras.
Wristed robotic instruments improve dexterity and enable more complex intraoperative procedures including intracorporeal suturing and complex anastomoses.
In robotic surgery, the surgeon assists themselves and controls the entire operation including dissection and exposure, displacing one staffing member.
More advanced or complicated revisional surgeries are being performed on robotic platforms compared to laparoscopic ones, suggesting intuitive selection of robotics for harder cases.
The Da Vinci XI platform is what should be used for robotic bariatric surgery; other platforms are outdated and don't provide the same support.
Development of a robotic stapler in the latter half of the last decade was the last piece to equalize laparoscopic versus robotic surgery.
Obesity hurts kidneys and obesity hurts transplanted kidneys.
Urologists want robotic surgery because they don't learn laparoscopic suturing like general surgeons do.
Robotic technology is still in its infancy.
Two other robotic platforms are coming on the market this year, which should create competition and improve instruments and decrease costs.
Laparoscopic sleeve gastrectomy can be performed with a medical student assistant without taking excessive time.
Guillermo Ares' robotic operative time cut in half between his first and second robotic cases and continued to decrease.
Turnover time between robotic cases is similar to laparoscopic when there is a dedicated robotic team, but palpably longer without one.
Wristed instruments and 3D vision are better than straight instruments and 2D vision.
Once a surgeon has done robotic surgery, they want to only do robotic surgery because it is so much better than laparoscopic.
Studies using EMG, motion tracking, and questionnaires show statistically significant increased muscle strain, postoperative pain, and overuse of muscles in surgeons performing laparoscopic versus robotic surgery.
Statistically significant change in surgeon irritability is quoted after robotic versus laparoscopic surgery.
Studies show decreased conversion to open in robotic revisional bariatric surgery compared to laparoscopic.
A retrospective study from 2015 to 2020 showed that over time, more robotic cases were performed, complication rates decreased, OR times decreased significantly (in some centers to no difference versus laparoscopic), and sicker patients and more revisional cases were done robotically.
Simultaneous robotic sleeve gastrectomy and kidney transplants are being performed on morbidly obese patients with no increased complications or blood loss and good 1-year kidney function with significant weight reduction.
Comparative studies between robotic and laparoscopic bariatric surgery show really no difference in outcomes.
A large study from the MBSQIP database of almost 800,000 patients showed slightly lower infectious complications with robotic Roux-en-Y but higher infectious complications with robotic sleeve, and higher 30-day readmission and reoperation rates with robotic surgery.
Centers performing robotic bariatric surgery repeatedly with dedicated OR robotic teams are able to achieve operative times almost as fast as or the same as laparoscopic surgery.