The Role of Robotics in Revisional Surgery

While conventional laparoscopy is the gold standard for almost all bariatric procedures, robotic assistance holds promise for facilitating complex surgeries and improving clinical outcomes. Numerous publications since the report of the first robotic-assisted bariatric procedure in 1999, including those reporting comparative trials and meta-analyses across bariatric procedures with a focus on robotic assistance, can be found. On the other hand, the majority of patients who undergo a restrictive procedure need a revisional surgery for inadequate weight loss or surgical complications, with a conversion to a Roux-en-Y gastric bypass or biliopancreatic diversion. Revisional bariatric procedures remain a surgical challenge, carrying a high risk of postoperative morbidity. In addition, the number of revisions is expected to increase in coming years. In parallel, robotics has been developed to overcome the natural limits of standard laparoscopy. Advanced and complex procedures have been reported as safe and feasible by means of a robotic approach. For bariatrics, several series are now available, displaying better outcomes after a robotic Roux-en-Y gastric bypass by comparison to laparoscopy. Several groups have reported a reduction in terms of anastomotic leakage or anastomotic stenosis with a robotic approach . The digital interface of the robotic system with the option to integrate augmented reality and real-time imaging will allow advanced applications, particularly in difficult fields such as patients with previous gastrointestinal surgery. In this lecture, Dr. Keith Kim explains the current role of robotics in bariatric revisional surgery, as well as its most recent results and the advantages that can be achieved through this challenging and innovative approach.