Published in:
01-10-2020 | Obesity | Multimedia Article
Really Totally Robotic SADI-S in a Patient with Extreme Morbid Obesity and Non-Reducible Umbilical Hernia: Case Report
Published in: Obesity Surgery | Issue 10/2020
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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.