Totally robotic gastric bypass: approach and technique.

Despite the advantages of the da Vinci robotic system in the performance of abdominal surgery (Maeso et al. Ann Surg 252:254-262, 2010), there has been limited application of this technology to bariatric surgery. The robotic platform may be ideal for performance of Roux-en-Y gastric bypass (RYGB), providing significant ergonomic advantage and greater ability to maneuver more precisely in limited spaces. However, there has been slow adoption of robotic technology for the performance of the RYGB procedure due, in part, to the perceived difficulty of conversion from laparoscopic to totally robotic procedures and the associated initial increase in operative time. In this report, we describe our approach to developing a standardized totally robotic technique with focus on patient safety and attention to operative times, the technique itself, and surgery outcomes of nearly 300 RYGB cases. Our findings show that totally robotic RYGB can be safely approached through systematic stepwise progression with minimal complications and comparable operative times.