August 16, 2005

Robotic Weight-Loss Surgery Appears Safe

NEW YORK -- Keyhole or "laparoscopic" surgery for obesity can be safely performed with a completely robotic approach, new research indicates. Whether this represents a real surgical advance or just a more expensive way of doing things, however, is hotly debated.

With the robotic approach, mechanical arms are attached to the instruments that the surgeon would normally hold. To operate, the surgeon sits at a console with video monitor and moves attached instruments that activate the mechanical arms. In the present study, the console was in the same room as the patient, but it can be located hundreds of miles away, allowing for "telesurgery."

Senior researcher, Dr. Myriam J. Curet, from Stanford University in California, told Reuters Health that the robotic approach offers several advantages over standard laparoscopy and has the potential to accelerate the learning of this procedure.

The weight loss operation, known as laparoscopic Roux-en-Y gastric bypass, is a challenging procedure and it's estimated that surgeons need to do 75 to 100 cases to master it, Curet noted. "So we were interested in finding a way to make the learning process easier."

Curet explained that they robotic system her team used, called the da Vinci system, has a number of features that help surgeons operate. For example, the system generates a three-dimensional image, which makes it easier for surgeons to tie knots compared with standard laparoscopy, which only features a two-dimensional image.

In the present study, reported in the Archives of Surgery, Curet's team compared the operating times and outcomes of 10 obese patients treated with robotic gastric bypass and 10 who underwent the standard laparoscopic procedure. Curet noted that this is the first study describing the use of robotics to perform the entire operation.

The operating time for the robotic approach was 169 minutes, significantly shorter than the 208 minutes seen with the standard approach. Even though the difference may not seem like a lot, time spent in the operating room under general anesthesia is very expensive and the risk of complications increases.

No differences were seen between the groups in complication rates or the length of stay in the hospital, the report indicates.

Despite these findings, not every surgeon is ready to step down from the operating table and sit behind a robotic console.

Dr. Mitchell S. Roslin, director of obesity surgery at Lenox Hill Hospital in New York, told Reuters Health that "there is no advantage for the robot for the established (weight-loss) surgeon with considerable laparoscopic experience."

Roslin also believes that the 208-minute surgical time cited for the standard laparoscopic approach is excessively long. "Our average case runs 70 minutes. When you look at someone who is reporting 208 minutes, it means that they are very junior in the learning curve."

For general surgical procedures, such as gastric bypass, "robotics offers equivalent results to standard laparoscopy, in a more cumbersome and expensive manner," he emphasized.

Curet countered that "the study wasn't intended for established surgeons who've done hundreds of procedures, but for the people who are first learning to do gastric bypass." To Roslin's point, she added that "operative times of 2, 3 and 4 hours are not at all unusual for" inexperienced surgeons.

Still, Curet believes that the robot can serve as more than a training tool. "Even surgeons who are past the learning curve, like Dr. Roslin, may benefit from the robotic approach. I wouldn't expect the robot to shorten his operative times, but it may offer other advantages, such as making surgery easier" on patients with the most severe obesity.

The da Vinci system, which is produced by US-based Intuitive Surgical, Inc., was approved by the Food and Drug Administration last year for use in heart bypass surgery.

SOURCE: Archives of Surgery, August 2005.