Gazi University Faculty of Medicine Department of General Surgery Faculty Member Prof. Dr. Abdulkadir Bedirli says that obesity is among the health problems that are increasing in the world and in our country and that threaten public health. Bariatric surgery is among the methods used to end obesity, which can cause many health problems such as diabetes, cardiovascular diseases, neurological disorders and even cancer. Bedirli gave important information about bariatric surgeries performed with robotic surgery.
What is obesity?
Obesity can be defined as the state of having excessive weight that impairs one's health. The degree of obesity is determined by the body mass index, which is calculated according to the height and weight of the person recommended by the World Health Organization. According to this measurement, those with a body mass index between 30 and 39 are obese, and those over 40 are in the morbidly obese group.
The most ideal treatment approach in morbidly obese patients is to lose their excess weight with diet and exercise. However, a significant portion of obese individuals experience weight loss problems despite all conservative approaches. This can lead to a decrease in the quality of life of people and many diseases such as type 2 diabetes, hypertension, coronary artery disease, heart failure, respiratory failure, sleep apnea, reflux disease, degenerative joint diseases, polycystic ovary disease, which will impair the health of the person over time.
Who can have bariatric surgery?
The surgeries performed on morbidly obese patients are called bariatric surgeries. Bariatric surgeries can be applied to patients with a body mass index above 40, who cannot lose weight with diet and exercise, or who have a body mass index between 35-40 and have one or more of the above diseases that may be caused by obesity. The most common bariatric surgeries today are sleeve gastrectomy (tube stomach surgery) and gastric bypass surgery. While sleeve gastrectomy has only a restriction effect, gastric bypass surgery provides both restriction and reduction of the absorption of food from the intestines to a certain extent.
How does robotic surgery contribute to bariatric surgeries with the developing technology?
Robotic surgery is the most advanced technologically advanced laparoscopic surgery. The robotic arms we use in robotic surgery are wrist-controlled, ergonomic and eliminate vibration and provide freedom of movement for the surgeon. The 3-dimensional robotic camera prevents the loss of depth sense and has a better magnification capacity, giving the surgeon a feeling of their hands inside the patient's body. Robotic surgery is an operation performed by the surgeon sitting on a console separate from the patient. A disadvantage of robotic methods is that the cost is higher than laparoscopic surgery.
What is done to prepare for robotic stomach reduction surgery?
Nutritional habits are regulated in order to ensure the pre-operative preparations of the patients. Additional medical procedures are carried out for the drugs used by the patients and their additional diseases. Patients are admitted to the hospital the night before the surgery. Intestinal preparation is done in patients. Preoperative anticoagulant procedures (blood thinner needle, pneumatic stockings) are applied to the patient. The surgery is performed under general anesthesia.
After general anesthesia, the camera and trocars for the robot arms are placed in the abdomen. The arms of the robot are attached to these trocars. Then, the robot instruments are advanced into the patient's abdomen, and the process we call docking is completed. After docking, the surgeon moves to the unit we call the console, sits down, leans his head on the console, looks at the 3-dimensional screen with 8-10 times magnification and uses the robotic instruments in the patient's abdomen. The operation is completed under the full control of the surgeon sitting on the robotic console from start to finish.
How long does it take until the patient is discharged after robotic surgery?
Robotic bariatric surgeries take an average of 1-2 hours, depending on the type of surgery. Patients can be discharged on the first or second day after surgery. It is recommended that patients use gastric protective and blood thinners for a certain period of time after surgery. The dietitian regulates fluid intake and nutrition after surgery.
After 15 days, the patient is re-examined for diet change. The blood tests of the patient are examined at the 1st month, 3rd month, 6th month and 12th month after the operation. In order to enable patients to lose weight permanently, body composition analyzes are performed at specified times and patients are supported with vitamin, mineral and protein components when necessary.
How is weight loss experienced after stomach reduction surgery?
Patients lose the most intense weight in the first six months after surgery. During this period, if patients follow the diet and exercise, they can lose their excess weight to a large extent. The weight loss process continues for two years. Weight loss is fastest in the first six months. The first six months are important for the patient to both correct their eating habits and change their lifestyle for a healthy life.
At the end of this process, in addition to losing weight, patients get rid of many health problems such as type 2 diabetes, hypertension, sleep apnea, which are triggered by obesity. Patients gain more comfortable mobility. Joint diseases that were present before the surgery can be eliminated. Infertility is an important problem of obese individuals. In addition to losing weight, female patients are more likely to become pregnant. However, for pregnancy, it is necessary to wait 2 years after bariatric surgery.
What advantages or disadvantages does robotic surgery have compared to other methods?
Bariatric surgeries are surgeries that result in anatomical and physiological changes in important organs. Complications such as bleeding, leakage, wound infection, atelectasis, and pulmonary embolism may occur. However, these complication rates are below 1%. There are two important elements. First of all, the pre-operative preparation and post-operative follow-up of the patient for whom bariatric surgery will be planned is extremely important. Secondly, it is the experience of the surgeon performing the surgery and the medical equipment adequacy of the hospital where the surgery is performed. As a result of the experience of surgeons in bariatric surgery and additional technological advances, these surgeries are successfully applied in our country. Recent advances in robotic technology have made the robotic method an important option against laparoscopy in bariatric surgery.
