Identifying Workflow Disruptions in Robotic-Assisted Bariatric Surgery: Elucidating Challenges Experienced by Surgical Teams.

Purpose: Bariatric surgery is an effective and durable treatment for weight loss for patients with extreme obesity. Although traditionally approached laparoscopically, robotic bariatric surgery (RBS) has unique benefits for both surgeons and patients. Nonetheless, the technological complexity of robotic surgery presents new challenges for OR teams and the wider clinical system.

A novel description of converting a gastric plication to sleeve gastrectomy for weight loss: A case report.

Introduction: Bariatric surgery is a rapidly growing field with trends and standards of care changing more rapidly than most. Gastric plication was once an exciting novel procedure which showed promise, however it has fallen out of favor for other procedures such as the sleeve gastrectomy. Existing literature on the surgical conversion of a gastric plication to a sleeve gastrectomy does not provide specific details on the operative technique of this rarely encountered operation.

Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial.

Background: Roux-en-Y gastric bypass surgery is the leading surgical treatment of morbid obesity in the United States. The role of preoperative weight loss in gastric bypass surgery remains controversial. We performed a prospective randomized trial to determine whether preoperative weight loss results in better outcomes after laparoscopic gastric bypass.

Postural ergonomics during robotic and laparoscopic gastric bypass surgery: a pilot project.

We hypothesized that a laparoscopic technique for Roux-en-Y gastric bypass surgery is associated with more musculoskeletal discomfort and ergonomic strain than a robotic technique. This pilot project studied one surgeon while he performed four laparoscopic and four robotic (da Vinci system) Roux-en-Y gastric bypass procedures. We measured musculoskeletal discomfort with body part discomfort score (BPD) and ergonomic positioning with the rapid upper-limb assessment tool (RULA).

Comparison of totally robotic laparoscopic Roux-en-Y gastric bypass and traditional laparoscopic Roux-en-Y gastric bypass.

Background: Laparoscopic gastric bypass is a technically demanding operation, especially when hand-sewing is required. Robotics may help facilitate the performance of this difficult operation. This study was undertaken to compare a single surgeon's results using the daVinci Surgical System with those using traditional laparoscopic Roux-en-Y gastric bypass (LRYGB) when the techniques were learned simultaneously.

Totally robotic laparoscopic Roux-en-Y Gastric bypass: results from 75 patients.

Background: A technique for Totally Robotic Laparoscopic Roux-en-y Gastric Bypass (TRL-RYGBP) has been reported previously. In this paper, we report our experience with our first 75 TRLRYGBP operations, including the training of three laparoscopic fellows. We describe changes in technique that have evolved with more experience, lessons learned, and the results from a larger series.

Orogastric tube complications in laparoscopic Roux-en-Y gastric bypass.

Background: Recent national efforts have focused on improving patient safety in surgical procedures including examining adverse events. An adverse event in laparoscopic Roux-en-Y gastric bypass (LRYGBP) which has not received much scrutiny involves orogastric tube complications during gastric pouch formation.

Methods: Retrospective review was conducted of all LRYGBPs (n=727) performed by 5 surgeons over 5 years at 2 institutions.

Incidental finding of gastrointestinal stromal tumors (GISTs) during laparoscopic gastric bypass.

Background: Gastrointestinal stromal tumors (GISTs) are rare tumors, accounting for <1% of all neoplasms of the alimentary tract. GISTs have not been previously reported in association with gastric bypass surgery.

Methods: This study is a retrospective review of 517 consecutive morbidly obese patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP) between January 2002 and August 2005.

Laparoscopic Roux-en-Y gastric bypass at a Veterans Affairs and high-volume academic facilities: a comparison of institutional outcomes.

Background: Outcomes of bariatric surgery have been linked to institutional case volume. The objective of our study was to compare outcome of laparoscopic Roux-en-y gastric bypass (RYGB) in 2 settings: a low-volume Veterans Affairs (VA) and a high-volume university hospital (UH).

Methods: Over a period of 27 months, 140 patients underwent RYGB (137 laparoscopic, 3 open) performed by 1 surgeon.

Magnetic resonance imaging is not needed to clear cervical spines in blunt trauma patients with normal computed tomographic results and no motor deficits.

Hypothesis: Trauma patients with normal motor examination results and normal cervical spine helical computed tomographic (CT) scans with sagittal reconstructions do not have significant cervical spine injury.

Design: Prospectively collected registry data.

Setting: Level II community-based trauma center.

Cervical spine clearance in blunt trauma: evaluation of a computed tomography-based protocol.

Background: Prompt identification of cervical spine injuries has been a critical issue in trauma management. In 1998, the authors developed a new protocol to evaluate cervical spines in blunt trauma. This protocol relies on clinical clearance for appropriate patients and helical computed tomography instead of plain radiographs for patients who cannot be clinically cleared.

Local anesthetic infusion pumps improve postoperative pain after inguinal hernia repair: a randomized trial.

Pain after an open inguinal hernia repair may be significant. In fact, some surgeons feel that the pain after open repair justifies a laparoscopic approach. The purpose of this study was to determine if the use of local anesthetic infusion pumps would reduce postoperative pain after open inguinal hernia repair.

Essential techniques for intraoperative composite endograft (CEG) formation in the treatment of abdominal aortic aneurysm.

The development of an ideal aortic stent graft continues to progress. New devices and techniques are expanding the use of endovascular repair in the treatment of abdominal aortic aneurysms (AAA). We present data with intraoperative composite endograft (CEG) techniques evaluating immediate and short-term compatibility of components and patients outcome.