More precision and smaller incisions.
These are the main benefits that modern robot-assisted surgery brings to bariatric surgery, a procedure that helps with weight loss that’s been offered by Care New England Health System for the past two decades but only recently using the latest technology in the form of the da Vinci Xi Surgical System.
“It’s just incredible,” said Dr. Jeannine Giovanni, who’s now completed 20 robot-assisted weight loss procedures at Kent County Memorial Hospital in Warwick, guiding surgical blades using her fingers on a remote console, sitting about 2 feet from the patient. “The way you can manipulate your hands – you can get so much finer movement with the robot,” she said. “It allows you to be more precise in how you perform the surgeries.”
Care New England said Kent Hospital is the only facility in Rhode Island that’s currently offering bariatric surgery with robot assistance. The first robot-assisted gastric bypass, a type of bariatric surgery, was conducted 22 years ago by Dr. Santiago Horgan at the University of Illinois at Chicago. But the robot-assisted weight loss surgery has recently been adopted by more hospitals across the country, replacing another minimally invasive but manually conducted technique called laparoscopic surgery, an advancement that has replaced traditional open surgery, Giovanni said.
The robot-assisted bariatric surgeries had been conducted before at The Miriam Hospital in Providence, owned by Lifespan Corp., which has two da Vinci surgical robot systems, according to a spokesperson for the organization. Saint Anne’s Hospital, located in Fall River and owned by Steward Health Care System LLC, claims that it was the first hospital in the region to offer robot-assisted weight loss surgery in 2020, using its own da Vinci system, which is manufactured by Intuitive Surgical Inc.
Giovanni said conducting bariatric surgery with the da Vinci Xi Surgical System requires less dexterity for the surgeon, allowing her to sit down instead of hovering over the patient.
“It’s definitely more comfortable for a surgeon to perform robotic than laparoscopic, which involves instruments shaped like chopsticks,” she said. “You’re sitting at a comfortable console. Instead of clutching instruments that only move in a limited direction, with the robotic instruments, you can move them in any degree and any way that you want to.”
The other major benefit to using the da Vinci robot system is that it is equipped with a 3D camera that probes the inside of a patient and gives the doctor a perfect view, better than the laparoscopic cameras, Giovanni said.
‘It allows you to be more precise.’
DR. JEANNINE GIOVANNI, Kent Hospital bariatric surgeon
“The camera is different. It allows for a lot better visualization of the anatomy,” Giovanni said. “There’s more high definition. You can actually see structures much [more] clearly than open or laparoscopic. It allows for an ability to reach farther.”
So, does robot-assisted bariatric surgery make the procedure safer?
Giovanni, who has been leading bariatric surgery operations since 2005, said moving from open surgery to laparoscopic surgery led to quicker recoveries, shorter hospital stays and fewer complications, such as leakage of gastrointestinal fluids through staples or sutures, and ulcers in the stomach or small intestine. Robot-assisted surgeries take those improvements to the next level, she said.
“There have been some studies that show there are less bleeding complications with the robot,” Giovanni said. “Particularly, what’s important is that many patients who are obese have heartburn or reflux. That’s generally caused by a high hiatal hernia. It’s important to fix it when doing these surgeries. Otherwise, patients are more at risk of this complication after a sleeve procedure. With a robot, it’s easier to identify a hiatal hernia and fix it.”
Michael McDermott, a married 52-year-old father of three from Barrington, is one of Giovanni’s patients and is a beneficiary of bariatric surgery. While he wasn’t able to take advantage of the new robotic procedure, he said the laparoscopic surgery was life-changing, after he reached 405 pounds as a result of a sedentary lifestyle as a software engineer. The last straw – after he failed at getting into a regular exercise routine due to nagging injuries, and too often gave in to food cravings – was an episode of atrial fibrillation that sent him to the cardiologist, who suggested weight loss surgery.
McDermott, now in the range of 235 to 240 pounds, said his family is glad to see him on the right track, continuing to coach youth and high school basketball, and now exercising regularly with free weights and a rowing machine while consuming about 1,700 calories per day. McDermott said he’s glad others will now have the option of robot-assisted surgery, making suturing more precise and the recovery process more comfortable.
“The surgery itself is not a cure-all,” said McDermott, who underwent the procedure at Kent Hospital in late November, staying there for about a day afterward, before slowly reintroducing solid foods within three months.
“You have to switch how you eat and your exercise habits,” he said. “The fortunate thing is the surgery can help make that a lot easier. You’re not carrying as much weight. You don’t eat as much. … If I were to eat a normal size sandwich, I would feel like anyone does after Thanksgiving when they’re stuffed and can’t eat for the rest of the day. I have to eat less. The stomach just can’t handle it.”
Marc Larocque is a PBN staff writer. Contact him at Larocque@PBN.com.