Page 4 - Journal of Laparoscopic Surgery
P. 4

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
          stomach. Gastrolysis is performed from 5 cm  (authors vary:  patients. Available data on robotic sleeve gastrectomy
          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
          sleeve is created over size 38 Fr  (size 32 F14-60 F) bougie  gastrectomy of about 33 to 90% in a review study of
          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
          especially when sleeve gastrectomy is intended as a sole pro-  from 40 to 67.7 kg/m  for robotic sleeve surgery and 35 to
          cedure for morbid obesity. The staple line is imbricated with   74 kg/m  for standard laparoscopic sleeve studies.
          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
          From published data, the average operative time varies from    Trelles N and Gagner M.
          65  to 120 minutes  in the standard laparoscopic sleeve      The percentage of main complications was reported less
          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
          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
          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
          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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