Robotic implantation of gastric electrical stimulation electrodes for gastroparesis

Gastric electrical stimulation (GES) is a low-morbidity treatment option that may be effective for refractory symptoms in patients with gastroparesis of diabetic or idiopathic etiology. During surgery to initiate GES, two electrodes are tunneled in the gastric antrum in a precise location. If these electrodes pass through the mucosa and into the gastric lumen (determined by endoscopy) they must be repositioned, often multiple times. During this procedure, extensive suturing to anchor the electrodes is necessary once properly placed. Robotic surgical systems may provide surgeons with several technical and ergonomic advantages during this procedure when compared with a standard laparoscopic approach.

Over a 26-month period, 22 GES systems were implanted. The initial procedures were performed laparoscopically. After the first 15 laparoscopic cases, a technique for robotically implanting leads was developed and employed for the remainder of the series. Demographics, operative time, and endoscopically confirmed electrode mucosal perforations were quantified and compared based on operative approach.

Patients were similar demographically. Total operative time did not differ based on technique (152 +/- 40 min laparoscopic versus 158 +/- 38 min robotic placement; p = 0.6). Mucosal perforations on first attempt at electrode placement occurred more frequently with the laparoscopic than with the robotic technique (15/30 laparoscopic versus 1/14 robotic; p = 0.006). There were no procedure-related complications.

The robotic approach to GES electrode implantation is feasible and safe. Compared with standard laparoscopic techniques, the accurate insertion and anchoring of these leads can be accomplished more efficiently and comfortably using robotic techniques. Whether robotic GES electrode placement will result in significant clinical advantages for patients will require long-term follow-up.