Robotic Bariatric and Metabolic Surgery

What is robotic bariatric and metabolic surgery?

  • Bariatric surgery is a surgical procedure performed to reduce weight and this type of surgery shows improvement in people with body mass index above 35kg/m2 along with obesity-related diseases. 

  • Metabolic surgery is an intervention done over the gastrointestinal tract to control blood sugar levels. 

  • Bariatric/metabolic surgery is an effective therapy to treat both morbidly obese and non-morbidly obese patients.

  • Robotic bariatric and metabolic surgery is a surgical procedure using robotics. 

What are the indications for bariatric surgery?

Bariatric surgery is done in patients with a body mass index of 35 kg/m2 or more.

It is also considered for patients with a body mass index of more than 30 kg/m2 with obesity‑related complications such as type 2 diabetes, hypertension, dyslipidemia, etc. 

What are the indications for metabolic surgery?

Metabolic surgery is considered for patients with a body mass index of 30 kg/m2 or more with type 2 diabetes mellitus, uncontrolled or on medications. 

Is robotic bariatric and metabolic surgery considered safe?

Yes, mounting evidence from research suggests robotic bariatric and metabolic surgery to be a safe option.

Is bariatric and metabolic surgery effective?

Evidence suggests bariatric and metabolic surgery to be effective. Some of the benefits of metabolic surgery include 

  • A study showed a 75% excess weight loss one to two years post-surgery and more than 50% excess weight loss after 10 years post-surgery. 

  • Analysis of several study results showed that cancer and cardiovascular mortality was 50% less after the surgical procedure. 

  • A weight loss from bariatric-metabolic surgery leads to better improvements in type 2 diabetes mellitus. Randomized controlled trials proved that obesity and type 2 diabetes mellitus treated from bariatric-metabolic surgery show better outcomes than medical treatment in controlling increased blood sugar and cardiovascular risk factors. 

  • Evidence also suggests improvements in other obesity-related complications such as asthma, reflux disease, obstructive sleep apnea and a significantly improved quality of life post-surgery.

What are the different types of robotic bariatric and metabolic surgeries available?

Robotic surgical procedures that can be performed include:

  1. Laparoscopic Adjustable Gastric Banding

  2. Laparoscopic Sleeve Gastrectomy

  3. Laparoscopic Roux en Y Gastric Bypass

  4. Laparoscopic Mini Gastric Banding

  5. Biliopancreatic diversion with duodenal switch

  6. Revision Bariatric surgery

What are the advantages of robotic bariatric and metabolic surgery over laparoscopic surgery?

  • Robotic bariatric and metabolic surgery has fewer complications such as fewer leaks, bleeding, and stricture as compared to laparoscopic surgery. 

  • Robotic surgery is associated with a shorter length of stay at the hospital.

  • It produces better imaging and more freedom of movement during operation compared to laparoscopic surgery.

What are the limitations of robotic bariatric and metabolic surgery?

  • Robotic bariatric and metabolic operations are longer in duration compared to laparoscopic surgery. 

  • Robotic surgeries are more costly. 

Is there a difference in the amount of weight loss in robotic bariatric and metabolic surgery as compared to laparoscopy?

A study showed that the percentage of weight loss was similar in both types of surgical procedures. 

After the surgical procedure, when can I ambulate?

A patient should ambulate as early as possible. We suggest ambulation on the same day of the surgery. Walking or moving around will lead to faster recovery, lesser days spent in the hospital, lesser postoperative complications, and overall better functional status. 

After the surgical procedure, when can I begin my diet?

A patient may begin on a clear liquid diet as early as possible. Studies show that early initiation of diet leads to fewer complications, shorter duration of hospital stay, and less mortality and better patient recovery. 

What are the common side effects that a patient may experience post a surgical procedure?

  • Nausea and vomiting: Patients may experience postoperative nausea and vomiting. Antiemetic drugs may be provided when necessary. The doctor may advise you a liquid diet, small and frequent quantities of meals to avoid such problems. 

  • Pain: Patients may experience minimal pain post-surgery. Since it is either laparoscopic/robotic, early ambulation and adequate analgesics reduce the pain significantly.

 

Dr. Randeep Wadhawan

HOD And Consultant -  Bariatric & Metabolic Surgery & Gastrointestinal Surgery

Manipal Hospitals, Dwarka, Delhi

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