Robotic-assisted removal of a gastric band

This video demonstrates the robotic-assisted removal of a previously placed gastric band. All salient aspects are presented and discussed.

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Robotic-assisted removal of a gastric band

Authors

M Vix, J Marescaux

Abstract

This video demonstrates the robotic-assisted removal of a previously placed gastric band. All salient aspects are presented and discussed.

Classification

robotic

Keywords

gastric band, robot, removal, robotic-assisted surgery

Media type

Surgical video

Duration

06'50''

Publication

2008-01

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E-publication

WeBSurg.com, Jan 2008;8(01).
URL: http://www.websurg.com/doi-vd01en2243.htm

Robotic-assisted removal of a gastric band

1. Anatomical considerations regarding gastric band positioning 00'15''

This video shows the robotic-assisted removal of a gastric band. Here on the schematic we can observe the standard operative technique employed at the time the band was placed. We focus on the perigastric area and observe exactly where the band was placed. A thorough dissection of the lesser omentum was carried out in order to identify the retrogastric channel. This helps position the band correctly around the stomach. Three stitches are placed on the anterior aspect of the stomach.

2. Procedure commencement with standard laparoscopy 00'50''

An optical trocar is then introduced half-way between the xiphoid process and the umbilicus. A panoramic exploration is performed at that stage.

3. Initial adhesiolysis 01'00''

Then four 5-12mm ports are introduced. These will facilitate our dissection and our retraction maneuvers. We first encounter adhesions from previous surgeries. These adhesions are taken down using the Ligasure device. The use of a liver retractor helps us to achieve a better exposure of the operative field. It will also be an aid during adhesiolysis.

4. Commencement of robotic-assisted dissection 01'33''

Once this step has been achieved, we continue with the dissection of adhesions between the left liver and the band. We are using the robot at this stage because it allows us to perform a blunt and sharp dissection all along the gastric band. In these cases we prefer to use monopolar cautery and traction is achieved through the use of a grasper held in the left hand. The dissection is performed all along the anterior surface of the band, first towards the lesser omentum and then towards the angle of His. At this stage, extreme caution must be paid not to divide the stomach. The objective of this part of the dissection is to find the closure system.

5. Identification of band closure mechanism 02'49''

We then use sufficient traction on the closure system to achieve the posterior division of the suture material. The band has a specific feature. It bears a few fixation arcs which were used during its placement.

6. Division of band fixation hook attachments 03'14''

These will be progressively divided as we proceed with the dissection. Once again, we go back to the closure mechanism of the band and we complete the dissection of the tissue which maintains it into place. It is always important to use sufficient traction when performing such maneuvers. Once this is achieved, we can then start to exteriorize the system and we proceed with the final adhesiolysis.

7. Adhesiolysis of band catheter tubing 04'10''

8. Division of gastric band 05'40''

Having done this, we can now divide the gastric band. At this stage, traction is achieved from the cut margins of the band. We continue with the division of both adhesions and suture material around the band until complete extraction is possible through the 12mm optical port. The operative field is checked and the operation ends.

9. Extraction of gastric band 06'30''