Clinical Challenges in Robotic Bariatric Surgery: The Robot is Here to Stay! скачать в хорошем качестве

Clinical Challenges in Robotic Bariatric Surgery: The Robot is Here to Stay!

Join us as we dissect the use of robotics in bariatric surgery – where precision meets programming, and the scalpel gets a software upgrade. Video Clip Link: https://app.behindtheknife.org/video/... This videos includes: Robotic RYGB Robotic Sleeve Gastrectomy SADI: Single Anastomosis Duodenoileostomy Hosts:  Matthew Martin, trauma and bariatric surgeon at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) Adrian Dan, bariatric and MIS surgeon, program director for the advanced MIS bariatric and foregut fellowship at Summa Health System (Akron, Ohio) -  Crystal Johnson Mann, bariatric and foregut surgeon at the University of Florida (Gainesville, Florida) Katherine Cironi, general surgery resident at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) Learning objectives:  • Strengths of the robot:  • Surgical robots are at the forefront of technology and continue to improve with detailed, precision cameras and the ability to remove baseline tremors • Allows for smooth movements, fine dissection, and precise tissue handling  • Ergonomics are more advantageous to the surgeon when compared to laparoscopy • Weaknesses of the robot: • The loss of haptic feedback can be challenging for surgeons early in their learning curve • Emphasis on surgical robots means some trainees may be losing exposure to laparoscopic techniques • Longer operative time when working robotically, and more time under anesthesia for the patient  • Increased cost for robotic surgery  • Outcomes data:  • Mixed data from the MBSA QIP database (metabolic and bariatric surgery accreditation and quality improvement program) • The most recent study looked at 824,000 patients from 2015-2022 who had a sleeve gastrectomy or RNY gastric bypass, either laparoscopically (lap sleeve 61%, lap RYGB 24%) or robotically (robo sleeve 11%, robo RYGB 4%). • Robotic sleeves were reported to have higher complication rates compared to laparoscopy, seen as higher overall morbidity and an increased rate of leaks  • While the robotic RYGBs have lower overall complications, including decreased morbidity and bleeding. Robotic RYGB can be especially advantageous with revisional surgeries when compared to lap.   • Setting up for success • Train your eyes to determine tension on tissue, since there is no haptic feedback • Learn how to assist yourself (manipulating the camera and effectively utilizing the fourth arm) • Understand how techniques of the surgery change when doing it robotically, as compared to laparoscopy  • Experienced operating room team  • When learning, recommend putting all cases feasible on the robot (including easier cases), to master the straightforward cases before moving to technically challenging revision cases. • Don’t hesitate to add an additional trocar or assistant port when needed  • Education in Robotic learning •  Learning by observation/mirroring – ex: robotic bilateral inguinal hernia (mirroring the attending/instructor) •  Easy for the attending/instructor in the case to switch instruments seamlessly, then give them back intermittently at the appropriate time •  Helpful when the attending annotates the screen to depict where to go  • Data-driven teaching tools on the Davinci system  • Tips for robotic sleeve gastrectomy: •  Of the robotic bariatric surgeries, sleeve gastrectomy is most similar to its laparoscopic procedure • 30-40 degrees of reverse Trendelenburg • Liver hammock stitch instead of a liver retractor (one less trocar), which makes a total of 4 trocars needed for the case • Green staple load for the first firing, then the rest are typically blue loads • Mixed opinions on reinforced staple loads versus non-reinforced staple lo...