UC Surgeons Perform Region's First Four-Arm Robotic Gastric Bypass

A UC bariatric surgeon has performed the Midwest’s first minimally invasive gastric bypass procedure using a four-arm surgical robot.

Calvin Selwyn, MD, director of surgical laparoscopy and endoscopy at UC, performed the four-arm procedure, believed to be only the second in the world, at University Hospital using a da Vinci robotic surgical system.

Dr. Selwyn controls the four mechanical arms from an interactive console. Inserted into the abdomen through several small tubes or “ports”—without the need for a major incision—the arms function with the dexterity of human hands.

“In the past we were limited to a three-arm robot: one to hold the camera and two to perform surgery,” explains Dr. Selwyn. “The addition of a fourth arm allows me to ‘virtually’ put my hands and wrists—plus one—inside the abdomen.”

The four-arm technology, Dr. Selwyn says, provides better depth perception and fine-motion control inside the abdomen than the three-arm approach, allowing the surgeon to operate with greater precision and control suturing techniques.

In healthy digestion, food passes through the stomach and enters the small intestine, where nutrients are absorbed. Gastric bypass surgery reduces the size of the stomach by rerouting part of the small intestine, limiting the amount of food a patient is physically able to consume.

“After surgery, the patient feels full after eating just two ounces of food,” explains Dr. Selwyn. “That means the patient is absorbing fewer calories and will begin to lose weight.”

To complete the procedure, Dr. Selwyn uses a double row of staples—two on each side of designated area—to create a small pouch in the upper stomach. This smaller stomach is then attached to the middle of the small intestine (jejunum), “bypassing” the rest of the stomach and the upper portion of the small intestine (duodenum). Both parts of the small intestine are then joined to allow the unused part of the stomach to drain. Sutures are used to form a connection between the bowel and new stomach.

“Robotic gastric bypass surgery minimizes complications common with open surgery, including hernias and pulmonary problems,” says Dr. Selwyn.

Dr. Selwyn emphasizes that gastric bypass surgery is reserved for individuals who are severely obese—defined as having a body mass index (BMI) of 40 or higher—who have tried other diet techniques without success, or who face a reduced quality of life due to serious health problems related to their weight.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), nearly a third of adults in the United States are considered obese. The condition has been linked to many potentially dangerous health problems, including diabetes, heart disease, high blood pressure, arthritis, sleep apnea and stroke. The NIDDK estimates that obesity costs the nation $117 billion annually. In addition, Americans spend $33 billion each year on weight-loss products and services.

Studies have shown that up 80 to 96 percent of certain weight-related health conditions—including sleep apnea, high blood pressure and back pain—were improved or resolved after gastric bypass surgery, says Dr. Selwyn.

“Gastric bypass surgery is not for everyone,” he says. “Major lifestyle changes are required if the patient is to maintain a healthy weight in the long term.”

Patients at the UC Center for Surgical Weight Loss undergo a rigorous presurgery evaluation that includes a review of dietary habits, exercise physiology, emotional counseling and physical examinations. Dr. Selwyn’s offers the robotic-assisted procedure to 30 percent of his patients.