Robotic bariatric surgery: A new weapon in the fight against obesity
September 26, 2019
Weight-loss surgery is one of the most transformative procedures a patient can go through. It changes your appearance, your eating habits, and it can have a profound effect on your physical and psychological well-being.
The procedure itself, also known as bariatric surgery, has evolved dramatically as well.
Two decades ago, when I first performed a gastric bypass as a resident at the University of Iowa, it was an open, technically difficult operation with big incisions, which put patients at increased risk for wound-related complications, hernias, and infections.
Needless to say, acceptance was limited.
But in the early 2000s, we began performing weight-loss surgeries – Roux-en-Y gastric bypass, sleeve gastrectomy, and lap band – laparoscopically. The minimally invasive tools and techniques meant smaller incisions for patients, less pain, and quicker recovery times. It quickly became the gold standard.
Now, the next frontier in bariatric procedures has arrived.
Late last year, I performed the first robotic sleeve gastrectomy at UT Southwestern. The gastric sleeve, which is the most popular choice among our patients, involves removing the stretchiest portion of the stomach, reducing it from the size of a football to the size of a small banana.
Since that robotic procedure, the patient has lost more than 60% excess body weight, and thanks to UT Southwestern’s comprehensive approach to pre- and postoperative care, has maintained that significant weight loss.
A decade from now, I expect that there will be a robot in every operating room. But in 2019, the technology is still in a transition period, which means it is incumbent on physicians to study outcomes and prove that it has significant benefits for our patients.
‘Playing video games with my body’
In many ways, bariatric surgery is one of the most misunderstood procedures in modern medicine.
Some patients and physicians still consider it elective and extreme, even though for people battling obesity (a body mass index above 35), it is the most effective tool for sustained weight loss, according to the National Institutes of Health Experts Panel.
Bariatric surgery is as safe as having your gallbladder or appendix removed, and it helps reverse or reduce the risk of many health problems related to obesity, such as Type 2 diabetes, heart disease, hypertension, high cholesterol, and obstructive sleep apnea. It may also reduce your risk of developing certain types of cancer.
Yet only 1% to 2% of people who are eligible for bariatric surgery actually get the procedure.
Given that context, you can imagine that some patients might express trepidation when they hear the word “robotic” in the same sentence as bariatric surgery. Visions of sci-fi movies flash into their head.
“I just want you, Doc,” a few patients have told me. They don’t want “someone playing video games with their body,” and I understand that.
But I do assure patients – including those who want robotic surgery – that the robot is not really doing the surgery. We control the hands; we control the camera. Nothing happens independent of the surgeon. There is always someone at the bedside, and I scrub in to get the robot properly positioned with the patient before we begin.
Pros and cons of robotic bariatric surgery
For those who are interested in robotic surgery, there are some very real benefits:
- Better vision: The robot has binocular vision, which increases depth perception and a provides a sharp 3D view for the surgeon.
- Smaller incisions: With only an 8 mm incision – less than 1/3 of an inch – robotic surgery leaves fewer visible scars and reduces the risk of infection.
- Better range of motion: Robots have “wrists” and their instruments provide a broader range of motion than laparoscopic equipment, which has a lobster-like claw grip.
- Better ergonomics: The robot enables the surgeon to sit at a console with controls within easy reach. This prevents physician arm or leg fatigue and offers more precise positioning during the one- to three-hour procedure.
- Shorter hospital stays and recovery times: This minimally invasive approach will often mean less time in the hospital, less pain, and a quicker return to work for patients.
- Revisional surgery: Robotics can provide added precision when dealing with adhesions or scar tissue from a prior operation.
As with any new technology, there are also a few drawbacks:
- The learning curve: Many doctors graduating from medical school and residency today have robotic skills, but others must acquire them. I did lab simulations, computer simulations, and then spent hours practicing on inanimate objects in UT Southwestern’s SIM center. As a surgeon, you have to log the time and raise your skill set.
- Robots don’t have true haptics, or touch: Because physicians are sitting at a console and looking at a screen, they don’t get the tangible feeling of interacting or touching the tissue, but the technology is evolving quickly, and I suspect that will be addressed in the next generation of robots.
- The cost: Surgical robots are expensive – most cost more than $1 million – so it is incumbent on the medical community to reduce expenses in other areas, such as shortening hospital stays and recovery times for patients.
UT Southwestern’s general surgery team is compiling a database of robotic procedures - not just for bariatrics - to track outcomes, complications, and recovery times. I think the numbers will show that robotic surgery will yield long-term benefits for patients and health care providers.
Weight-loss surgery options
Dr. Benjamin Schneider, chief of the bariatric surgery team at UT Southwestern, describes the options and procedures for laparoscopic weight-loss surgery. Robotic surgery is an option for some patients and is particularly effective in revisional surgery.
A legacy of innovation in bariatric surgery
Robotics is just the latest bariatric surgery milestone at UT Southwestern, where specialists have performed more than 4,000 operations and trained more than 100 board-certified surgeons. Our list of accomplishments includes:
- First to perform gastric banding with single-incision laparoscopic surgery (SILS) in North Texas (2008)
- First to perform laparoscopic adjustable gastric banding (lap band) in North Texas (2001)
- First to perform the laparoscopic Roux-en-Y gastric bypass in North Texas (1999)
The bariatric team also recently expanded it services and began seeing patients at two locations, Clements University Hospital and partner hospital Texas Health Presbyterian Dallas. In December, we will expand again with the opening of UT Southwestern Medical Center at Frisco.
As an accredited academic medical center, we are training the next generation of surgeons and we know the robot we’re using today won’t be the robot we will be using five years from now. So we must continue to adapt and incorporate the best technology for the betterment of our patients.
When I did my residency in the late ’90s at the University of Iowa, I worked in the same labs and operating rooms where Dr. Ed Mason first invented the gastric bypass. He was a pioneer, and I am sure today, well into his 90s, he must be astounded by the progress and possibilities surrounding the life-changing procedure he created.
At UT Southwestern, our team is dedicated to building on that legacy.