Background

Laparoscopic sleeve gastrectomy is the most common bariatric procedure worldwide. Robotic surgery establishes a new age of minimally invasive surgery. Standard guidelines for robotic-assisted sleeve gastrectomy (RSG) require the use of four robotic arms, with an additional fifth port required for liver retraction. Our institution uses a novel approach using three ports and a homemade intracorporeal liver retractor with successful outcomes. We performed a retrospective review of eighty-two consecutive and non-randomized patients undergoing RSG at Tallahassee Memorial HealthCare from January 2020 to February 2021. All patients are classified as Class II morbidly obese. We excluded fifty-three patients due to simultaneous procedures or prior bariatric surgery. This twenty-nine patient cohort had a mean age of 43 years with an initial mean BMI of 46, and 79% were female. The mean operative time was 1.2 hours, and most cases had a surgical resident's active participation. There was a maximum 2-day stay, and most were discharged on a postoperative day one (62%). The thirty-day readmission rate was 3.8% (four patients) and included treatment of non-fatal pulmonary embolism, superficial wound care, and nausea (3%, 3%, and 7%, respectively). This cohort had no postoperative pneumonia, urinary tract infections, deep tissue infections, leaks, strictures, or deaths. Mean weight loss at 3 and 6 months follow up were 36.8 and 59.4 pounds, respectively. This study demonstrates the feasibility and safety of our technique is comparable to the traditional robotic approach.