Background

With the rising number of bariatric procedures, there are also a growing number of patients requiring revisional operations due to operative complications or weight loss failure. The use of the robotic platform might offer several advantages in this setting. The aim of this video is to review the applications and potential technical advantages of the robotic approach during revisional bariatric surgery.

Methods

A series of short videoclips with different revisional bariatric operations performed with the robotic system.

Results

The first patient was a 45-year-old female who underwent a gastric band to bypass conversion for weight regain. The second case was performed in a 46-year-old female with a previous band to sleeve gastrectomy conversion. A new conversion to Roux-en-Y gastric bypass was performed for insufficient weight loss and severe gastroesophageal reflux. The third patient was a 43-year-old female with a previous gastric bypass. She presented with severe malnutrition refractory to medical therapy and a bypass reversal was indicated. The last patient was a 31-year-old female with a biliopancreatic diversion. The patient presented with severe malabsorption refractory to medical treatment and underwent a full biliopancreatic diversion reversal.

Conclusions

Robotic approach for revisional bariatric surgery has multiple indications and it is gaining popularity. The robotic platform might be especially useful in the most complex revisions due to its high-definition imaging, multi-quadrant access, direct camera control by the surgeon, and endowristed instruments for fine dissection and suturing.