TECHNOLOGICAL IMPROVEMENTS:
ROBOTIC SYSTEM AND BARIATRIC SURGERY: IS IT WORTH IT?
Robotic is a recent advance in surgery, particularly in video-assisted mini-invasive surgical procedures requiring manual sutures. Indeed using stitches and manipulating sewing intruments can be greatly facilitated by a robotic system. One of the first promising fields has been heart surgery (coronary bypass). Different procedures have been attempted in laparoscopic abdominal surgery with a robotic system, and recently gastro-jejunal bypass .
The principle is simple and attractive: an assistant prepares the instruments, inserts trocars inside the abdomen, as well as an optical device connected to a vidéo system; he will stay close to the patient during the procedure for safety reasons and will change the instruments.The surgeon seats outside the operating room, and manipulates from there specific instruments for dissection, suturing, etc., thanks to a remote control station. This station has a monitor for tri-dimensional vision and a tactile device for remote control of the robot arms. The central part of the robot reproduces accurately the surgeon's moves, which make it possible to use reliable suturing devices (commonly used during gastric bypass). Several centers have tried it successfully.
An Italian team lead by du Pr Parini (Val d'Aoste) has reported its preliminary experience of 11 patients operated on with the Da Vinci robot. This device was available in his hospital for 2003 and has been used in 70 various interventions*. Mean duration of operation has been 201 minutes (125 to 250). No complication has been reported. It is premature to draw any conclusion, and a cost-efficiency analysis has not been established so far. It is supposed that the sewing will be hand made, whereas many surgeons use stapling devices. In other bariatric procedures, such as lap-banding, the interest of the robotic system is at least questionnable.

* Robot-assisted gastric bypass with Da Vinci system. Preliminary experience. U Parini et col. Journal of coelio-surgery, 2004, 50: 64-70.