[Clinical application analysis of remote robot-assisted sleeve gastrectomy and bariatric anti-reflux surgery]

Objective: To evaluate the safety and feasibility of remote robot-assisted sleeve gastrectomy with concomitant anti-reflux surgery. Methods: A descriptive case series study was conducted. We retrospectively enrolled 7 patients who underwent remote robot-assisted sleeve gastrectomy with concomitant anti-reflux surgery, which was collaboratively performed by Xinjiang Uygur Autonomous Region People's Hospital (operator side) and Aksu Prefectural First People's Hospital (patient side) from October 2025 to March 2026. Baseline characteristics, intraoperative parameters, intraoperative network performance, and 3 month postoperative followup data were collected. The outcomes analyzed included weight loss efficacy [percentage of excess weight loss (%EWL) and percentage of total weight loss (%TWL)], antireflux effect (GERDQ score), and incidence of complications. Results: A total of 7 patients undergoing remote bariatric surgery were enrolled, including 1 male and 6 females. Among them, 2 patients had a history of previous abdominal surgery, 2 had hypertension, 1 had diabetes mellitus, and 1 had reflux esophagitis. The mean age was (36.4±6.2) years. During remote surgery, the mean latency at the operator side and the patient side were (73.29±3.73) ms; the average packet loss rates were (0.06±0.03)% and (0.02±0.02)% respectively; the mean upload speed before and after master-slave operation were (190.89±81.98) Mbps and (71.22±10.28) Mbps;and the mean download speed before and after master-slave operation were (144.00±58.93) Mbps and (78.13±18.56) Mbps respectively. no operation lag or signal interruption occurred throughout the procedure. The mean preoperative body weight of the patients was (117.57±17.72) kg, and the mean body weight at 3 months postoperatively was (91.66±8.44) kg. The mean preoperative body mass index (BMI) was (41.74±4.48) kg/m², and the mean BMI at 3 months postoperatively was (32.67±2.64) kg/m². The median preoperative GERD-Q score was 8 (interquartile range, Q1, Q3: 6, 11), and the GERD-Q score at 3 months postoperatively was 6 (Q1, Q3: 6, 7). At 3 months after surgery, %TWL was (21.32±6.75)%, and %EWL was (53.47±13.89)%. In terms of postoperative complications, there were 2 cases of dysphagia (water swallowing test [WST] grade ≥ 2), 1 case of constipation, 2 cases of chest pain, 2 cases of alopecia, 2 cases of abdominal distension, and 1 case of vomiting. Among these patients, those with chest pain, abdominal distension, vomiting, and WST grade≥2 dysphagia achieved gradual and spontaneous resolution by 3 months postoperatively, while the symptoms of constipation and alopecia showed no significant improvement. Conclusion: Remote robot-assisted sleeve gastrectomy and sleeve gastrectomy with concomitant anti-reflux surgery are safe and feasible.