Page 4 - Journal of Laparoscopic Surgery

RF Ijah et al
cannulas under the guidance of the standard laparos copic of complications negatively impact on sleeve patients and
camera (and docking of robotic arms) and retracting the liver, prolong their hospital stay.
the essential steps commences from the greater curvature The prime target of sleeve surgery is to effectively
with the division of the gastroepiploic and short gastric reduce excess weight and therefore reduce the negative
vessels at the gastrocolic and gastrosplenic omentum up to impact this has on the morbidity (obstructive sleep apnea,
the left crus of the diaphragm, thus completely freeing the diabetes mellitus, hypertension, osteoarthritis, etc.) of the
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stomach. Gastrolysis is performed from 5 cm (authors vary: patients. Available data on robotic sleeve gastrectomy
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2 cm, 4 cm, 10 cm ) proximal to the pylorus up to the revealed percentage excess weight loss of 65.5 ± 25.6% at
angle of His. Approximately, 100 to 150 ml (60-200 ml ) of 1 year. This also is comparable to that of standard sleeve
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sleeve is created over size 38 Fr (size 32 F14-60 F) bougie gastrectomy of about 33 to 90% in a review study of
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using Echelon Flex linear stapler with 60 mm. Smaller size 940 patients,18 and 60.8 ± 4.3% in a study of 25 patients.
bougie and shorter distance from the pylorus are preferred, The mean preoperative body mass index (bMI) varied
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especially when sleeve gastrectomy is intended as a sole pro- from 40 to 67.7 kg/m for robotic sleeve surgery and 35 to
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cedure for morbid obesity. The staple line is imbricated with 74 kg/m for standard laparoscopic sleeve studies.
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PDS (polydioxanone) 2-0 continuous sutures to reduce The follow-up duration of available studies varied from
the risk of leakage and bleeding. Peroperative endoscopy is 3 to 12 months for robotic sleeve and 4 months to 5 years
done to rule out intraluminal bleed/leak and biovac drain is for SLSG with an average of 1 year. There appeared to be
placed in perisleeve region. a fall (35%-71.6% at 6 months, 45-83% at 1 year, 47-83%
A comparative measure of the speed of surgery for at 2 years and 66% at 3 years) in the peak of percentage of
both procedures is the duration of surgery (operative time). excess weight loss achieved after a while as reported by
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From published data, the average operative time varies from Trelles N and Gagner M.
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65 to 120 minutes in the standard laparoscopic sleeve The percentage of main complications was reported less
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method. This wide gap could probably be accounted for by in robotic sleeve than in SLSG. Miller N et al in a study of
the method employed in re-enforcing the staple line (over- 317 patients demonstrated this in a ratio of 5:12% in favor of
sewing takes longer time than use of prosthetic material), RSG. The precision and high maneuverability of the robotic
experience and learning curve of the different surgeons. arms coupled with the comfort of the sitting surgeon at the
Reported operative time for robotic sleeve gastrectomy console, would have significantly contributed to this more
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varies from 70.1 to 165 minutes with overall average than double complication rate.
of 101.1 minutes. Similar factors also apply. If the docking It is worth noting from available studies that the follow-
time (and undocking time) of 16 ± 4.2 is subtracted, only ing issues still call for attention for possible consensus: its
then will robotic sleeve gastrectomy (RSG) be considered use as single-stage procedure; use of intragastric balloon in
to be shorter. high-risk and super-obese patients; resection distance from
the pylorus; the size of the gastric bougie used (hence size
of remaining gastric pouch), variation of bougie size with
MeASuReS OF OuTCOMe
degree of obesity; reinforcement of the staple line and type
There are few publications on the outcome of RSG for morbid of material used.
obesity with highlight on percentage excess weight loss, The aim of this study, therefore, is to compare RSG with
duration of hospital stay (and cost of operation), quality of SLSG done for morbid obesity with regards to operative time
life (QOL) and complications encountered. The relatively and short-term patient outcome in a developing country.
new status of the procedure may have strongly contributed
to this. Also, available studies are of short follow-up duration MATeRIALS And MeThOdS
and hence could not draw reasonable conclusions on long- Retrospective comparative study was done in a minimal
term outcome of this procedure. access bariatric surgery unit of a busy hospital over 21 months
The duration of hospital stay for RSG varied from (data collection of surgeries from October 2011 to October
2.5 to 4 days, comparable to that of standard laparo- 2012, and follow-up to June 2013). Data was collected for
scopic sleeve gastrectomy (SLSG) (4-4.4 days). However, 20 RSG and 20 SLSG (obtained by systematic sampling of
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Frezza EE reported the shortest of 1 day in a review the total number of SLSG during the study period.
of 10 patients. burgos AM, in a study describing gastric
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leak after laparoscopic sleeve gastrectomy , reported Inclusion Criteria

a mean hospital stay of 28.8 days among 214 patients. Patients with bMI³ 40 kg/m², patients aged between 30 and
It appears reasonable to conclude therefore that occurrence 60 years.
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