Robotic Surgery for Weight Loss: Greater Precision, Control and Clarity

Robot enhanced minimally invasive surgery is the latest advance in bariatric surgery. In the following Q&A, Dr. Abraham Krikhely explains what patients need to know about this new approach.

What is robotic weight loss surgery?

Robotic laparoscopic bariatric surgery is something we are excited to offer to our patients. It is the latest evolution in surgical technique.

For the past twenty or so years, Columbia surgeons have led the development of bariatric surgery with the use of laparoscopy. Small tools and a camera are inserted through tiny incisions and the operation is minimally invasive. This has allowed easier recovery, less pain and better outcomes. Almost all of our weight loss surgeries are done in this manner. However, laparoscopic instruments have limitations, like range of motion, and other challenges. Robotic surgery helps overcome many of these.

Robotic surgery has been around for years, but with recent refinements in the technology, we have been using it more often with our bariatric patients. When someone asks me about robotic surgery, I explain that it’s the same surgery we’ve been doing, only with a different set of tools.

How does the robot work?

This isn’t R2-D2 standing over you, performing the operation. The surgeon is still in charge. A better name might be “robot-enhanced” surgery.

Instead of holding an instrument, the surgeon’s hand controls the robot. This machine can enhance precision, stability and visualization, making many aspects of the procedure more exact.

The robot also holds a camera, providing an exceptionally clear and steady view of the surgical field. Even the best surgical assistant is less steady than that. The robot’s movements are more refined and one of the results is better suturing.

What weight loss surgeries can be done with a robot?

I can do most of my bariatric surgeries this way. The sleeve gastrectomy and gastric bypass are two procedures that I perform most commonly with this approach. But a robot can help with many other operations as well – including surgeries for hernias, reflux and gallbladders.

Are there any instances where you wouldn’t use a robot?

Because robotic surgery it so precise, it can take a bit longer. I wouldn’t recommend it for very ill or compromised patients who need a weight loss procedure to be completed faster. I also wouldn’t take this approach in patients with significant adhesions from prior surgeries—but that’s a very small percentage of the people we treat.

What is the future of robotic surgery?

The robot enhances our minimally invasive approaches, adding better visualization, precision and stability. But the surgeon is still in control and the result depends upon his or her skill.

As technology develops, I suspect our utilization of robot platforms will increase. There are many companies working on making more, newer and better robots for surgical use – including Medtronic and Google. We are just at the beginning of the innovation curve. We haven’t yet even imagined all the possible uses.

I like to compare this to when the first iPhone came out. It only had a handful of applications. Now look at how far we’ve come and how much more it is capable of doing. I think we are at a similarly early phase in the innovation curve of robotic technology.

Research studies on robotic surgery in bariatrics have not yet been able to show a major difference in results. At the moment, we know it’s safe and we know it’s useful. As time goes by, and surgeons become more proficient, better stability, precision and visualization should lead to better outcomes.