Benefits of Robotic Camera Assistance in Minimally Invasive Bariatric Procedures: Prospective Clinical Trial Using a Joystick-Guided Camera-Holder.

BACKGROUND: While minimally invasive surgery is a growing sector in medicine, camera assistance remains a problem. Especially in bariatric surgery, the assistant holding the camera faces certain challenges. Furthermore, unless the surgeon controls the camera movement themselves, they will be challenged by an unstable image. The aim of this study was to investigate the benefits of a robotic camera assistant (SoloAssist®, AKTORmed™ GmbH, Barbing, Germany) in bariatric surgery. PATIENTS AND METHODS: Three hundred thirty one consecutive laparoscopic bariatric procedures were performed with the assistance of a camera robot, including Roux-en-Y gastric bypass, laparoscopic gastric banding, sleeve gastrectomy, and gastroplication. Failures and aborts were documented and 6 surgeons were interviewed regarding their experiences using a questionnaire. RESULTS: In 18 of 331 procedures, robotic assistance was aborted and the procedure was continued manually, mostly because of a need for frequent changes of position in narrow spaces and adverse angles. Two short circuits, 4 joystick faliures and one malfunction of the control unit were reported. All of the surgeons preferred robotic to human assistance, mostly because of a steady image and the capacity for self-control. DISCUSSION: The SoloAssist® is a reliable system for minimal invasive procedures, especially in bariatric surgery. It provides more comfortable conditions for the surgeon and their assistant by freeing one hand for other purposes. Even in narrow spaces (e.g., between a voluminous stomach and adipose liver), the robot guarantees a steady image. Slight movements of the camera can be precisely controlled, which leads to increased comfort for the surgeon.

Identifying the Bariatric Patient at Risk for Pulmonary Embolism: Prospective Clinical Trial Using Duplex Sonography and Blood Screening.

BACKGROUND: Thromboembolic complications continue to be one of the main reasons for perioperative mortality in bariatric surgery. There is no consensus on which is the safest and most effective thromboprophylaxis. This prospective study aims to evaluate the significance of thrombophilia screening and a venous duplex sonography in bariatric patients. METHODS: One hundred one patients were tested for coagulopathies (activated protein C (APC) resistance, factor II, antithrombin (AT)III, protein S and C). Perioperatively, the patients underwent a venous duplex sonography. A multimodal thromboprophylaxis protocol was set up: 2× 40 mg enoxaparin sodium per day and sequential pneumatic compressions of the lower extremities. RESULTS: In six patients, we identified previously unknown risk factors for thromboembolic complications. Protein S deficiency is found significantly more often in obese patients than in the general population. There are numerous risk factors which, in themselves, increase the risk of venous thromboembolism. In obese patients with obstructive sleep apnea or diabetes mellitus, thrombophilia is found significantly more often than in patients without these diseases. No postoperative thromboses occurred. CONCLUSIONS: The bariatric patient is a potential high-risk patient for venous thromboembolism. Thrombophilia is found significantly more often in obese patients than in the general population. Conceivably, existing conditions such as obstructive sleep apnea and diabetes mellitus have until today been underestimated regarding the entailing thrombosis risk. Thrombophilia screening and duplex sonography are possibilities for identifying patients at risk. The advantage of a reduced risk thanks to an adapted thromboprophylaxis based on the patient's individual risk profile justifies the relative increase in time and cost.

Robotic Camera Assistance and Its Benefit in 1033 Traditional Laparoscopic Procedures: Prospective Clinical Trial Using a Joystick-guided Camera Holder.

Despite advances in instruments and techniques in laparoscopic surgery, one thing remains uncomfortable: the camera assistance. The aim of this study was to investigate the benefit of a joystick-guided camera holder (SoloAssist®, Aktormed, Barbing, Germany) for laparoscopic surgery and to compare the robotic assistance to human assistance. 1033 consecutive laparoscopic procedures were performed assisted by the SoloAssist®. Failures and aborts were documented and nine surgeons were interviewed by questionnaire regarding their experiences. In 71 of 1033 procedures, robotic assistance was aborted and the procedure was continued manually, mostly because of frequent changes of position, narrow spaces, and adverse angular degrees. One case of short circuit was reported. Emergency stop was necessary in three cases due to uncontrolled movement into the abdominal cavity. Eight of nine surgeons prefer robotic to human assistance, mostly because of a steady image and self-control. The SoloAssist® robot is a reliable system for laparoscopic procedures. Emergency shutdown was necessary in only three cases. Some minor weak spots could have been identified. Most surgeons prefer robotic assistance to human assistance. We feel that the SoloAssist® makes standard laparoscopic surgery more comfortable and further development is desirable, but it cannot fully replace a human assistant.