Obesity is characterized by excess adipose tissue and defined by using the body mass index (BMI) based on world heath organization definitions (BMI > 30). Obesity is classified into mild (30-34.9), moderate (35-39.9), and severe (40 or greater). While we have documentation of obesity prior to the current millennium, obesity has become increasingly prevalent. During the last census in 2010, the CDC reported that 36% of American adults and 17% of American children were obese.
While we know that metabolic disease arises in adipose tissue, the link between obesity and metabolic disease is still not well understood, being complex and multifactorial. Obesity is associated with multiple medical comorbidities including metabolic disorder, hypertension, hyperlipidemia, atherosclerosis, hepatic steatosis, sleep apnea, and depression. While the first line of treatment for obesity is lifestyle modifications—such as dieting and exercise—by far the most efficacious is bariatric surgery.
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The Da Vinci by Intuitive has shown to be a reliable tool in minimally invasive bariatric surgery. It allows the surgeon to operate in patients with large body habitus that can be difficult to perform surgery on using standard laparoscopic surgery. It has been shown to offer more precision and better ergonomics, reducing surgeon fatigue and allowing for delicate maneuvers.
The Da Vince robot consists of a surgeon cart, patient cart, and vision cart (which communicates between the former two carts). Currently there are two models in use for bariatric surgery X and XI. The other two Da Vinci models include the S which is being phased out and the SP which is only FDA approved for single port site surgery. The use of the Da Vinci robot in robot assisted bariatric surgery has decreased overall operative time, hospital stay, and overall post operative complications.
When using the Da Vinci Robot, the initial entry into the abdomen is performed by the surgeon who then docks the patient cart at the bedside, the surgeon then leaves the bedside and performs the surgery at the surgeon cart, while an assistant is at the bedside with the patient cart.