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Gastric bypass after band removal: robotic-assisted gastrojejunostomy and linear-stapled jejunojejunostomy

M Vix, MD J Marescaux, MD, FACS, Hon FRCS, Hon FJSES, Hon FASA, Hon APSA
Epublication WebSurg.com, Oct 2012;12(10). URL: http://websurg.com/doi/vd01en3761

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Laparoscopic gastric bypass performed after gastric band removal requires the same surgical steps as a conventional gastric bypass. The presence of adhesions between the liver and the stomach makes the dissection of the superior gastric pouch more difficult. It is essential to correctly visualize the left crus during the dissection. When the gastric pouch has been created, the other steps of the intervention remain conventional. Our team is currently evaluating the interest of using the Da Vinci™ surgical robot in morbid obesity surgery. As a result, we regularly perform a hand-assisted gastrojejunal anastomosis using the robot. The anastomosis is therefore easier to perform as the robot offers specific degrees of freedom. Consequently, the surgeon benefits from a more ergonomic position. In order to substantially increase surgical time, we opted for a conventional jejunojejunal anastomosis without the assistance of the surgical robot.