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Obesity kills: no question about it. Cardiovascular events such as ischaemia, myocardial infarction and metabolic complications closely related to excess weight are the most common causes of death in Western countries, where the problem of overnutrition poses the opposite risks compared to developing countries. In Italy, the percentage of obese people is about 11% of the total population.
In cases of severe obesity, diet and exercise alone are often not enough because excess fat causes metabolic adaptations in the body and hormonal changes that are the cause of the obese patient’s biological condition.
In severe obesity, bariatric and metabolic surgery can help to achieve consistent and safe weight loss, resulting in a significant reduction in body weight that can be maintained over the long term. It improves co-morbidities associated with obesity, such as type 2 diabetes, hypertension, sleep apnoea and cardiovascular diseases, leading to a reduction in the need for medication. It also relieves joint pain and optimises hormonal regulation of appetite, improving both quality of life and longevity. Mental health benefits are numerous, with a reduction in obesity-related anxiety and depression.
A 2016 publication in Bariatric News was entitled ‘DaVinci breaks the limits of conventional laparoscopy’, and this is no coincidence. Bariatric/metabolic surgery techniques, which have been mainly performed using laparoscopy, are now even safer, more precise and less invasive with the advent of robotic surgery: this was the intuition of Dr Ralf Senner, a pioneer of robotic bariatric surgery with over 23 years of experience, who was the first to understand the many benefits that robots could bring to obesity surgery.
Dr Senner is currently President of the European Centre for Robotic Obesity Surgery (CECRO) and works in Rome at the Clinica Madonna della Fiducia, near San Giovanni in Laterano, one of the few reference centres in Europe and Italy for robotic metabolic bariatric surgery.
“Robotic bariatric surgery was first introduced 23 years ago in Munich, Germany, where we used one of the first robotic systems called Zeus at the Munich Robotic Surgery Clinic“, says Dr Senner. “Then came AESOP (Automated Endoscopic System for Optimal Positioning), followed by Socrates, which was a kind of tele-teaching system that allowed us to link up with the local surgeon from miles away to coordinate the procedure. Then came the Da Vinci robots, of which there are now two types, X and XI: it is the Da Vinci technology that is used in the CECRO centres“.
What are the advantages of robotic bariatric surgery over laparoscopic surgery? “Robotic surgery simply overcomes all the limitations of laparoscopic surgery”, explains Dr Senner. “First of all, robotics is much less invasive, which significantly reduces the need for post-anaesthesia pain relievers. Recovery times are also shorter, patients can walk more quickly and the risk of intra- and post-operative complications is significantly lower than with laparoscopy”. According to CECRO surveys, the complication rate in bariatric surgery is 0.5% with robotic surgery, compared to 15% with laparoscopy: this data is also confirmed by the Sweden Obesity Study Group.
The robotic bariatric procedures of sleeve gastrectomy and gastric bypass are both very effective, but they are also very different and have different indications.
In sleeve gastrectomy, about 70-80% of the stomach is removed, leaving a tubular portion: this significantly reduces the stomach’s ability to hold food, thus limiting food intake and inducing a feeling of fullness. In addition, the removal of part of the stomach reduces the production of ghrelin, an appetite-stimulating hormone produced by certain cells in the anterior wall of the stomach: the hunger/satiety mechanism is thus redefined and greatly improved.
On the other hand, a gastric bypass involves the creation of a small upper pouch in the stomach. This upper pouch is directly connected to a section of the small intestine, ‘bypassing’ the rest of the stomach and a section of the small intestine itself (between 150 and 200 cm). This reduces the absorption of nutrients and causes changes in intestinal hormones that can improve type 2 diabetes.
When is one procedure better than the other? “Sleeve gastrectomy is recommended for class 3 obesity, i.e. with a Body Mass Index* (BMI) of 40 or above and without metabolic syndrome or diabetes, while gastric bypass surgery is also preferable for patients with class 2 obesity with type 2 diabetes or any other type of metabolic syndrome”, explains Dr Senner.
Surgery for obesity with a BMI of 35-40 is indicated if there are one or two associated comorbidities such as diabetes, hypertension, sleep apnoea.
When it comes to robotic surgery, a special mention must be made of the SureForm robotic surgical stapler used in bariatric/metabolic surgery, which Prof Senner presented for the first time in Europe in Zurich in 2016.
“The second generation of the Da Vinci surgical stapler has the ability to measure the thickness of the stomach wall before it is cut in order to adjust the closing compression after the cut with 100% accuracy“, Dr Senner explains. “If, due to human error, the surgeon does not follow the calculated values, the surgical stapler will not allow the tissue to be cut: robotic precision avoids human error as well as intra- and post-operative complications”.
The Da Vinci robotic surgical stapler is an innovative device designed to improve the precision and safety of surgical sutures. Thanks to SmartFire technology, the surgical stapler automatically measures and adjusts tissue pressure, taking more than 1,000 measurements per second: this ensures uniform and precise suturing, perfectly adapted to tissue thickness.
The 2nd generation robotic surgical stapler also offers greater flexibility and control compared to traditional instruments, reaching the most difficult areas and improving the quality of stapling, making surgery safer and more efficient, providing high ergonomics for the surgeon and better results for the patient.
Robotic Surgery for Obesity: a new course module at UniCamillus
UniCamillus University is proud to announce that ‘Robotic Surgery for Obesity’ will be a module on the MSc Medicine and Surgery at UniCamillus University, taught by Dr Ralf Senner, the world’s leading expert in the field.
The module will provide students with advanced training in state-of-the-art robotic techniques used in bariatric and metabolic surgery, focusing on innovative procedures that reduce the risk of complications and improve clinical outcomes for patients with morbid obesity.
With this new module, UniCamillus aims to prepare a new generation of surgeons capable of using robotic technologies to treat obesity effectively and safely, representing medical and academic quality as well as the evolving nature of surgical practice.
This module will be included in the study plan from the academic year 2024-2025.
*The Body Mass Index (BMI) is a measure that helps to determine whether a person’s weight is appropriate for their height. It is calculated by dividing a person’s weight in kilograms by the square of their height in metres. For example, to calculate the BMI of a person who weighs 70 kilograms and is 1.75 metres tall, we divide 70 by 1.75 squared. The result indicates whether the person is underweight, normal weight, overweight or obese, according to the categories established by the World Health Organisation (WHO). If the result exceeds 30, the person is obese.
