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Monday, Jan. 25, 2021

New Option to Treat Obesity

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Robotics brings the future to bariatric surgery

It is certainly no secret that obesity is a serious and growing problem in the U.S. Recent CDC reports show almost 40 percent of adults over age 20 are obese, and 7.7 percent are severely obese. Currently, there are both surgical and nonsurgical options available to assist patients in tackling this issue.

Because it is so complex for all patients who have tried diet and exercise, behavior change and even medication throughout their lives with only limited and short-lived success, many finally decide to choose bariatric metabolic surgery, which offers the most powerful tool helping combat this problem. The most common surgical options include placement of a Lap- Band device, a Vertical Sleeve Gastrectomy or a Roux-en-Y Gastric Bypass. Each of these options is very different and should be thoroughly researched independently by the patient and with a qualified, ASMBS-certified bariatric surgeon.

Most bariatric surgeries are now performed with minimally invasive techniques, most commonly laparoscopic surgery. Laparoscopic bariatric surgery involves small incisions, all less than an inch, which are made in different locations around the abdomen. Laparoscopic probes are inserted into each incision. Each probe has a specific tool in it and a special camera allowing the surgeon to see the area of operation closely. With these small incisions, there is less trauma to the body, which offers less pain and a quicker recovery time from surgery.

A somewhat newer technology now used for bariatric procedures is robotic-assisted laparoscopic surgery. The Da Vinci Surgical System by Intuitive has been around since 1995. I was the first bariatric surgeon trained in this region. As an early innovator of the technology, I have seen the evolution of the Da Vinci System from its initial introduction to how advanced the technology is today. Because of these advancements, I am now utilizing this technology to treat the complexities of bariatric surgery.

With laparoscopic surgical procedures, the Da Vinci Surgical System enhances a minimally invasive procedure with sometimes fewer incisions, increased visual acuity and augmented dexterity. The Da Vinci system amplifies a surgeon’s skill set and is also an excellent teaching tool for surgical residents in training.

The surgeon comfortably sits at a console, which contains the control panel giving him or her complete access to all the tools and a view of the patient’s inside. The Da Vinci system delivers 3D high-definition vision to the surgeon, which magnifies by 10 times what the normal human eye can see. The instruments’ control systems are ergonomically designed, allowing the surgeon to operate tiny instruments with much more range of motion than that of a normal human hand.

The system has built-in “tremorfiltration” that corrects for natural movement, shake or even fatigue of the surgeon’s hand. With all these enhancements, a surgeon who is both well trained in his or her field and on the robot can take surgery to a new level.

Currently, the Da Vinci is used in the surgical fields of bariatric, colorectal and general surgery, gynecology, head and neck, thoracic and urologic surgery.

As more surgeons become trained in robotics, patients should ask their surgeons about their skills in this area. For bariatrics, the robot can be particularly helpful in reducing the length of stay in the hospital for patients and, in some cases, for reducing the amount of pain and down time experienced after surgery. In patients categorized as super obese with a body mass index (BMI) over 50, the robotic-assisted choice can be also helpful in these cases because the robotic arms counteract the resistance and tension of a thicker abdominal wall.

As with all surgical interventions, the bottom line in bariatric surgery is to be educated enough as a patient to ask the right questions, investigate your surgeon’s experience, training, outcomes and even patient reviews, all of which can help make a good choice for your own health care.

George R. Merriman II MD, FACS, FASMBS has over 30 years of surgical experience. He is the medical director of the Bariatric Center of Excellence at Christus Highland Hospital and is the first surgeon in the Christus Network to perform Robotic Assisted Bariatric Surgery. For more information on bariatric surgery and robotic surgery, visit ASMBS.com; Da Vincisurgery.com, FreedomFromObesity.com

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