Adaptive Technology

The da Vinci Xi surgical robot

Forward-thinking bariatric surgeons exercise the newest robotic technology in the operating room

WRITTEN BY Lauren B. Johnson
PHOTOGRAPHS BY (Dr. Mitchell) Brett Tighe; (woman) Nina Buday & (robot) courtesy of Intuitive

In 2007, Roper Hospital debuted the da Vinci robot, becoming the first hospital in South Carolina to adopt this technological advancement in minimally invasive surgery. Since then, Roper St. Francis Healthcare has emerged as a regional leader in robotic surgeries, utilizing the da Vinci Xi system for general, oncological, gynecological, colorectal and urological surgeries. This January, Dr. Kenneth Mitchell added bariatrics to that impressive CV when he performed the first robotic-assisted weight-loss surgery. As the medical director of Roper St. Francis Bariatric Surgery and Medical Weight Loss, Dr. Mitchell has performed over 3,000 bariatric surgical procedures over the last 22 years. Here, he explains why this innovative technology is such a good fit.

Dr. Kenneth Mitchell

HOUSE CALLS (HC): What exactly is bariatric surgery?
The surgical treatment of morbid obesity. Obesity is a chronic, lifelong disease where the body stores too much fat. Like lots of other health issues, early weight problems can be modified with behavior, but once the disease progresses, further intervention may be needed. When obesity reaches the level that I’m seeing the patient, we’re looking to surgery as treatment.

HC: How does the da Vinci robot work?
The da Vinci robot is a system where the surgeon operates laparoscopic instruments from a console, and the robot controls the instruments based on the surgeon’s movements.

HC: How did you previously perform bariatric operations?
Until 2001, I performed bariatric surgical procedures via an open approach. Then, we did surgeries laparoscopically for the next 20 years. The term is minimally invasive because instead of a big incision down the belly, smaller incisions are made across the bottom of the abdomen. The surgeon places a tube inside the abdominal wall and runs a camera through that tunnel. They use that visual to operate their instruments through small incisions. Now we’ve moved to robotics.

HC: How does robotic-assisted surgery improve upon laparoscopic surgery?
The instruments are a bit smaller and have wrists in them, so the range of mobility is much greater than with normal laparoscopic tools. The visualization is also enhanced. Instead of just looking at a TV screen, the surgeon has a 3D view. Better visualization means the surgeon can identify and avoid scar tissue from previous surgery. Revisional bariatric surgery is an emerging field, because currently about 12 to 15 percent of patients need more than one surgery to treat their obesity. Within the next five years, revisional bariatric surgery is projected to account for 25 percent of the bariatric surgical procedures performed in the United States.

HC: How else does this approach benefit patients?
Robotic surgery incisions are usually smaller than laparoscopic incisions. With the incisions being smaller and the precise way that the robotic arms move, patients experience less pain and discomfort after surgery. So far, we’ve been very pleased with the patient response.

HC: Is this type of surgery appropriate for every bariatric patient?
We are transitioning to utilize the da Vinci robot for 100 percent of our patients. We’re converting our practice entirely to robotics. Less than 10 percent of bariatric surgeries are performed robotically in the United States, so we want to be a leader in innovation by utilizing this new technology for the benefit of our patients.