A new approach for achieving successful introduction of robotic sleeve gastrectomy

Purpose: The use of robotic surgery has increased exponentially worldwide, as robots have versatile functions that can amplify the surgeon's skill. At the same time, reports of robotic approach for bariatric surgery are increasing. However, a common problem with the introduction of novel surgeries is a prolonged operation time. Therefore, an innovative approach should be developed prior to the introduction of a novel surgery to ensure patient safety. Method: This article describes robotic sleeve gastrectomy using the stapling-first technique in accordance with our newly revised task protocol, and evaluates the preliminary clinical results of robotic sleeve gastrectomy performed by a single surgeon between June 2021 and December 2022. Results: The cohort comprised 10 patients with a median body mass index of 40.3 (range, 38.1–45.8) kg/m 2 . The median operation time was 230 (range, 178–281) minutes and median console operation time was 164 (range, 119–204) minutes. The median time for each surgical phase was 72 (range, 39–86) minutes for stomach stapling, 46 (range, 34–66) minutes for suturing the staple line, and 36 (range, 24–48) minutes for stomach dissection. The median blood loss was 15 (range, 5–78) g. Our task protocol was accomplished in all patients and only case 1 was converted to laparoscopic sleeve gastrectomy. No patients experienced postoperative complications or gastroesophageal reflux. Conclusion: Robotic sleeve gastrectomy using the stapling-first technique was safely performed in the introductory phase by following the task protocol.