Bypass Gastrique avec un porte-aiguille robotisé - Pr Fabian RECHE
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Minimally invasive surgery creates new challenges for the surgeon. The use of long rigid instruments through rigid ports limits intra-abdominal degrees of freedom.

The objective is to evaluate a new concept of robotic instrument to overcome difficulties inherent to suturing task of laparoscopic gastric bypass procedure.

Methods : The tested instrument offers two motorized distal degrees of freedom: bending of the shaft to adjust needle positioning into the appropriate plane and unlimited axial rotation of the end effector to drive the needle through the tissue, while keeping an outer diameter of 5mm.

The patient was a 35 year old male with a body mass index of 47.

The instrument was used to perform the Roux-en-Y anastomosis during a laparoscopic gastric bypass.

Results : Laparoscopic suturing to create the conduit and the closure of mesenteric defects are an advanced skill and mastering this skill is a difficult process, especially because the angle between the needle holder and suture line is unparallel and triangulation is limited.

The combination of distal shaft bending and rotation of the end effector of the robotic needle holder offers fully articulating tip for easy maneuverability and unparallel access.

Conclusion : The use of this robotic instrument is a great help to perform anastomosis during laparoscopic gastric bypass by facilitating and improving surgeon gesture.