Page 3 - Journal of Laparoscopic Surgery

WJOLS
WJOLS

10.5005/jp-journals-10033-1209
Sleeve Gastrectomy for Morbid Obesity: Robotic vs Standard Laparoscopic Sleeve Gastrectomy Methods
OriginaL articLe

Sleeve Gastrectomy for Morbid Obesity: Robotic vs

Standard Laparoscopic Sleeve Gastrectomy Methods

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1 RF Ijah, Parveen Bhatia, Sudhir Kaltan, Mukund Khetan, Suviraj John, Vivek Bindal, Asfar Ali
ABSTRACT robotic methods. The choice of the method would therefore
depend on availability, surgeon’s skills, the patient’s informed
Aim: The aim of this study is to compare robotic laparoscopic choice and ability to afford.
sleeve gastrectomy with standard laparoscopic sleeve gastrec-
tomy done for morbid obesity with regards to operative time and Keywords: Robotic/standard laparoscopic sleeve gastrectomy,
short-term patient outcome in a developing world. Gastric/vertical sleeve gastrectomy, Robotic vs standard laparo-
scopic sleeve gastrectomy.
Background: Excision of the fundus and greater curvature
of the stomach in sleeve gastrectomy not only restrict intake How to cite this article: Ijah RF, Bhatia P, Kaltan S, Khetan M,
but also reduces the level of ghrelin in the circulating blood. John S, Bindal V, Ali A. Sleeve Gastrectomy for Morbid Obesity:
Obesity surgery has benefited from the advent of surgical robot Robotic vs Standard Laparoscopic Sleeve Gastrectomy Methods.
with its celebrated advantages (enhanced dexterity, precision World J Lap Surg 2014;7(1):1-6.
and control of endowrist instruments, with 7º of freedom, 90º
of articulation, intuitive motion and finger-tip control, motion Source of support: Nil
scaling and tremor reduction). How this new technology under Conflict of interest: None
development affect patient outcome has only been reported in
a few centers especially in the developed world.
InTROduCTIOn
Materials and methods: Data for 21-month retrospective
comparative study was collected from the records of 20 adult Central to the development and progression of obesity is
patients who had robotic sleeve gastrectomy (RSG) and 20
standard laparoscopic sleeve gastrectomy (SLSG) (obtained ghrelin, a peptide hormone secreted by X/A-like cells of the
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by randomized sampling of the total number of SLSG during oxyntic glands of the fundus (18-20 times than any other
the study period). site) of the stomach, which is involve in both stimulation of
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Results and discussion: Duration of surgery, cost of opera- hunger and growth hormone secretion. It has been found to
tion, duration of hospital stay, percentage excess weight loss 3-5
(%EWL)/BMI, quality of life, comorbidity resolution and compli- be an endogenous ligand for the growth hormone secreta-
cations were the measures of outcome studied in comparing gogues receptor (a specific G protein-coupled receptor) in the
RSG to SLSG. The mean duration of surgery of 143.05 minutes pituitary gland and hypothalamus thus, making this stimula-
for SLSG and 152.7 minutes RSG (ratio 1:1.07) were in agree-
ment with previous studies in which the duration of RSG was ting effect more potent (about seven times over) than that
longer than SLSG. The RSG mean docking time of 12.6 minutes of growth hormone releasing hormone. Also, the increase
in this study obviously contributed to increasing the total opera- in mRNA expression of hypothalamic neuropeptide Y
tive time.
The cost of surgery was found to be higher RSG 9000 USD (a potent stimulator of food intake) after intracerebroventri-
compared to 7500 USD for SLSG (ratio1.2:1). This value is cular administration of ghrelin in rodents, appear to demons-
relatively higher than that documented in a study in which 400 trate the orexigenic effect of this peptide. Thus, excision of
euros was quoted. Understandably, this varied from center to
center. Three patients (15%) were observed to have some signi - the fundus and greater curvature of the stomach in sleeve
ficant complications among the SLSG group as against one gastrectomy not only restrict intake but also reduces the level
patient (5%) in the RSG group. of ghrelin in the circulating blood.
Conclusion: Sleeve gastrectomy by robotic method in a deve- Obesity surgery has benefited from the advent of surgical
loping country experience, has comparative advantage over 6
standard laparoscopic methods in reducing complications, robot with its celebrated advantages. How this new techno-
though the duration and cost of surgery were higher in the logy under development affect patient outcome has only been
reported in a few centers, especially in the developed world.
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1 Senior Registrar, Chairman and Chief Consultant Surgeon
3-7 Consultant Surgeon
TeChnIque And OPeRATIVe TIMe
1 Department of Surgery, University of Port Harcourt Teaching
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Hospital, Port Harcourt, Rivers State, Nigeria The technique of surgery is similar for both robotic and
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2-7 Institute of Minimal Access, Metabolic and Bariatric Surgery standard laparoscopic sleeve gastrectomy with the excep-
Sir Ganga Ram Hospital, New Delhi, India tion of docking and undocking of robotic arms for robotic
Corresponding Author: RF Ijah, Senior Registrar, Department sleeve surgery. This involves longitudinal resection of the
of Surgery, University of Port Harcourt Teaching Hospital, Port greater curvature of the stomach from the antrum to the angle
Harcourt, Rivers State, Nigeria, e-mail: rexijah@gmail.com
of His. After achieving pneumoperitoneum, inserting trocars/
World Journal of Laparoscopic Surgery, January-April 2014;7(1):1-6 1