Background

Although the duodenal switch (DS) is highly successful in inducing long-term weight loss and disease resolution, the procedure is complex and technically challenging. The robotic platform with its 3-D vision, intuitive motion, enhanced dexterity, and ergonomics may reduce surgeon challenges and risks. Previous robotic DS studies have been primarily performed using ‘robotic-assistance’. In the present study, we have examined the outcomes of a series of ‘totally robotic’ (TR)-DS surgeries and compared these findings to DS procedures performed laparoscopic (Lap).

Methods

TR-DS surgeries were performed using the da Vinci Xi surgical system. Study groups included 20 TR-DS patients and 20 Lap-DS controls matched for age, BMI, and gender. All surgeries were performed by the same surgeon and under ERAS protocol. Outcomes included operative times, peri- and postoperative complications, and length of hospital stay (LOS).

Results

Characteristics of the TR-DS patients and Lap-DS controls were nearly identical: BMI=49.2, 49.1; age=45.0, 45.6; major co-morbidities=2.95, 3.0. Within the TR-DS series, operative times for the first 5 cases averaged 240 min but, thereafter, declined to a mean=185.2, an operative time comparable to the Lap-DS (184.8 min). With the TR-DS procedure, surgeon satisfaction was higher and fatigue considerably less than with laparoscopy. Three 30-day readmissions/reoperations and 0 mortalities occurred with TR-DS and two readmissions/reoperations with 1 mortality for the Lap-DS. TR-DS LOS was significantly lower than Lap-DS (1.24 vs. 1.67 days; p=0.02).

Conclusions

TR-DS is safe and efficacious with a low learning curve and surgical outcomes comparable, or superior, to conventional laparoscopy.