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Really Totally Robotic SADI-S in a Patient with Extreme Morbid Obesity and Non-Reducible Umbilical Hernia: Case
Jordi Tarascó Palomares1, Albert Caballero Boza2, Edward Sánchez Haro2
1Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Germans Trias i Pujol Hospital, Ctra de Canyet s/n, 08916, Badalona, Barcelona, Spain. jorditarasco@gmail.com.
Background:
Single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-s) is a well-known and accepted technique for extreme obesity but technically challenging in this group of patients and so frequently is performed as a laparoscopic staged procedure. Robotic devices such as Da Vinci® system may solve some limitations of laparoscopic surgery. The video shows a really totally robotic SADI-s (RTR-SADI-s) in a single stage on a patient with extreme morbid obesity and a non-reducible umbilical hernia.
Methods:
A 56-year-old female patient with BMI = 58 kg/m2 and a large non-reducible umbilical hernia was planned for a RTR-SADI-s. A Da Vinci Xi® model was used and neither laparoscopic assistance nor change of surgical table position was needed.
Results:
The patient was in 20° reverse Trendelenburg position during all the procedure, with open legs and arms in complete adduction. All trocars were robotic. After the umbilical hernia reduction, a 300-cm ileal loop was measured and temporarily attached to the right hypochondrium peritoneum. The gastric sleeve was performed 6 cm from the pylorus over a 36Fr bougie. A robotic hand-sewn four-layer duodenoileal anastomosis was performed with barbed absorbable sutures. Docking time was 8 min. Total operative time was 240 min, of which 165 min corresponded to the SADI-s procedure and 75 min to the reduction and reparation of the umbilical hernia. There were no complications during or after surgery, and the patient was discharged on the third postoperative day.
Conclusions:
Robotic platforms can significantly minimize the difficulty of bariatric surgery, allowing one-stage procedures in patients with extreme obesity that could require two-stage procedures in a laparoscopic approach.
