Da Vinci 'breaks the limits' of conventional laparoscopy

Any bariatric surgery is a big challenge for each surgeon. Sophisticated anatomy, special difficult anatomical peculiarities and obesity-associated comorbidities distinguish this kind of surgery from other surgical subspecialities.

This kind of surgery should consider all peculiarities of obese patients. These include an abdominal wall with a tremendous diameter, a big amount of fat among the omentum causing reduced visibility and very little space at the surgical field due to a big fatty liver and therefore obstructing the access to the stomach. All movements inside the abdominal cavity must be done carefully to avoid imminent complications.


There are clearcut advantages of robotic surgery to conventional laparoscopic procedures. These regard the anatomical peculiarities of excessive obese patients including better work ergonomics due to highly flexible instruments with a marked increase in movability of EndoWrist instruments in small spaces as well as a clearly improved view to the surgical field by view enhancement by a HD 3-D technique. All these advantages are much valued in other surgical procedures like radical prostatectomy among others.

Professor Ralf Senner head of bariatric robotic assisted surgery at the European Special Management Center of Obesity Surgery (ESCOS Swiss) has over 15 years’ experience in robotic surgery. On 14th April 2016, he performed a live sleeve with the da Vinci technique. He explained that work ergonomics increased by using the EndoWrist instruments and HD 3D created a new quality of minimal invasive surgery and increased the surgical skills of surgeons. Using the 4 arms technique facilitated easy coordination of the surgical steps.


In this live case, he demonstrated a sleeve gastrectomy performed via the da Vinci technique using the brand new EndoWrist instruments in a 4-arms technique. In a setting of HD 3-D view, a new quality of minimal invasive surgery in morbid obese patients was achieved.

Specifically, the EndoWrist computer-assisted stapling used in this performance is regarded as a highly inovative product. In the future it will very likely increase the quality level of resective as well as reconstructive surgical procedures, he explained., it will facilitate resection and anastomosis in bariatric surgery including sleeve gastrectomy, Roux-en-Y anastomosis as well as in the implementation of an Omega-loop Bypass.

This article was edited using materials provied by the European Special Management Center of Obesity Surgery (ESCOS Swiss)