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Introduction

In the face of a global obesity epidemic, the medical community is continually seeking innovative solutions to combat this pervasive health crisis[1]. Morbid obesity, characterised by a body mass index (BMI) of 40 or higher, poses significant challenges to both individuals and healthcare systems worldwide[2]. As traditional weight loss methods often prove insufficient for those grappling with severe obesity, bariatric surgery has emerged as a crucial intervention. Among these surgical options, gastric bypass has long been considered the gold standard. However, the landscape of obesity treatment is rapidly evolving, with robotic micro-surgery emerging as a promising frontier in minimally invasive techniques[3].

Robotic micro-surgery represents a significant leap forward in the field of bariatric procedures. By combining the precision of robotic technology with the expertise of skilled surgeons, this innovative approach offers enhanced control and accuracy during complex obesity surgeries. The da Vinci Surgical System, a pioneer in robotic-assisted surgery, has paved the way for more refined and less invasive procedures in various medical fields, including bariatrics[4]. The application of robotic systems in gastric bypass and other weight loss surgeries has shown promising results, with studies indicating shorter hospital stays, reduced postoperative pain, and faster recovery times compared to traditional laparoscopic approaches.

As we delve deeper into the realm of robotic micro-surgery for obesity treatment, it’s crucial to consider both its potential benefits and limitations. While this technology offers exciting possibilities, it’s important to note that it’s not the only option available. Alternatives to gastric bypass, such as sleeve gastrectomy and adjustable gastric banding, continue to play vital roles in the treatment of morbid obesity[5]. This article aims to explore the revolutionary potential of robotic micro-surgery in obesity treatment, its current applications, and its future prospects in reshaping the landscape of bariatric care.

Understanding Robotic Micro-Surgery

Robotic micro-surgery represents a significant advancement in the field of minimally invasive surgical techniques, particularly in the treatment of morbid obesity. This innovative approach combines the precision of robotic technology with the expertise of skilled surgeons, offering enhanced control and accuracy during complex bariatric procedures[6].

At its core, robotic micro-surgery utilises a computer-assisted electromechanical device to aid surgeons in performing intricate surgical manoeuvres. The most widely used system in bariatric surgery is the da Vinci Surgical System, which consists of three main components: a surgeon console, a patient-side cart with robotic arms, and a high-definition 3D vision system[4].

The surgeon operates from the console, controlling the robotic arms with precision while viewing a magnified, high-resolution 3D image of the surgical site. This setup allows for greater visualisation and dexterity compared to traditional laparoscopic techniques. The robotic arms, equipped with specialised instruments, can rotate and move in ways that surpass the capabilities of the human wrist, enabling surgeons to operate in tight spaces with unprecedented accuracy.

The evolution of robotic surgery technology has been rapid since its inception in the late 1990s. Initially developed for cardiac surgery, robotic systems quickly found applications in various surgical fields, including bariatrics. The first robotic-assisted gastric bypass was performed in 2000, marking the beginning of a new era in obesity treatment[7].

In the context of bariatric surgery, robotic micro-surgery offers several advantages over traditional methods:

Enhanced Precision: The robotic system’s ability to filter out hand tremors and scale movements allows for more precise suturing and tissue manipulation, crucial in procedures like gastric bypass.
Improved Visualisation: The 3D high-definition imaging provides surgeons with a clearer, more detailed view of the surgical field, enabling better identification of anatomical structures.
Increased Dexterity: The robotic arms can move in ways impossible for human hands, allowing surgeons to perform complex manoeuvres in confined spaces.
Reduced Physical Strain: Surgeons can operate from an ergonomic seated position, potentially reducing fatigue during long procedures.
Minimally Invasive Approach: Like laparoscopic surgery, robotic procedures typically require only small incisions, leading to less postoperative pain and faster recovery times for patients with obesity[8].

Despite these advantages, it’s important to note that robotic micro-surgery is not without challenges. The high cost of robotic systems and the specialised training required for surgeons can limit its accessibility. Additionally, the setup time for robotic procedures can be longer than for traditional laparoscopic surgeries.

As the technology continues to evolve, researchers are exploring new applications in bariatric surgery. For instance, robotic systems are being used to perform more complex procedures like revisional bariatric surgeries, which involve operating on patients who have undergone previous weight loss surgeries[9].

While robotic micro-surgery represents a significant advancement in obesity treatment, it’s crucial to remember that it’s not the only option available. Alternatives to gastric bypass, such as sleeve gastrectomy and adjustable gastric banding, continue to play vital roles in the treatment of morbid obesity. The choice of procedure depends on various factors, including the patient’s specific health conditions, BMI, and personal preferences.

As we continue to navigate the complex landscape of obesity treatment, robotic micro-surgery stands out as a promising frontier, offering new possibilities for precision, control, and patient outcomes in bariatric care.

Application in Obesity Treatment

The application of robotic micro-surgery in obesity treatment represents a significant advancement in the field of bariatrics. As the prevalence of morbid obesity continues to rise globally, the need for effective, minimally invasive surgical interventions has become increasingly urgent. Robotic systems have found particular utility in performing complex bariatric procedures, offering enhanced precision and control compared to traditional laparoscopic techniques[10].

Specific Robotic Micro-Surgery Techniques for Obesity

Robotic-Assisted Gastric Bypass: The Roux-en-Y gastric bypass, long considered the gold standard in bariatric surgery, has been successfully adapted for robotic systems. In this procedure, the surgeon uses robotic arms to create a small pouch from the upper part of the stomach and connect it directly to the small intestine. The precision offered by robotic systems is particularly beneficial in creating consistent, leak-free anastomoses (surgical connections between organs or vessels)[11].
Robotic-Assisted Sleeve Gastrectomy : This procedure involves removing approximately 80% of the stomach, leaving a sleeve-shaped remainder. Robotic assistance allows for more precise control during the stapling process, potentially reducing the risk of leaks along the staple line. The enhanced 3D visualisation also aids in navigating the complex anatomy around the gastroesophageal junction[12].
Robotic-Assisted Adjustable Gastric Banding: While less common than bypass or sleeve procedures, adjustable gastric banding can also be performed with robotic assistance. The robotic system’s precision is particularly useful in placing and securing the band without damaging surrounding tissues.

Enhancing Precision and Control

Robotic systems significantly enhance the surgeon’s precision and control during these complex procedures. The da Vinci system, for instance, provides a magnified, high-definition 3D view of the surgical site, allowing for better visualisation of critical structures. The system’s “wristed” instruments, capable of rotating 360 degrees, offer greater dexterity than traditional laparoscopic tools, particularly useful when operating in the confined space of the abdominal cavity[13].

Moreover, the robotic system’s ability to scale the surgeon’s hand movements and filter out natural hand tremors contributes to smoother, more precise actions. This level of control is especially crucial in bariatric procedures, where even small errors can lead to significant complications.

Potential for New, Innovative Procedures

The capabilities of robotic systems are opening doors to new, innovative approaches in obesity treatment. For instance, researchers are exploring the potential of robotic-assisted single-incision laparoscopic surgery (SILS) for bariatric procedures. This technique aims to further reduce invasiveness by performing the entire operation through a single small incision, typically at the navel[14].

Another area of innovation is in revisional bariatric surgery. As the number of patients requiring follow-up procedures after initial weight loss surgery increases, robotic systems are proving valuable in navigating the complex, altered anatomy these cases present.

Comparative Outcomes

Studies comparing robotic-assisted bariatric procedures to traditional laparoscopic approaches have shown promising results. While operative times are often longer for robotic procedures, particularly during a surgeon’s learning curve, other outcomes are generally comparable or favourable. For instance, some studies have reported lower conversion rates to open surgery, reduced blood loss, and shorter hospital stays for robotic-assisted procedures compared to laparoscopic ones.

However, it’s important to note that outcomes can vary depending on factors such as surgeon experience, patient characteristics, and specific procedural techniques. As with any surgical approach, the choice to use robotic assistance should be made based on individual patient needs and the surgeon’s expertise.

While robotic micro-surgery offers exciting possibilities in obesity treatment, it’s crucial to remember that it’s not the only option available. Alternatives to gastric bypass and other robotic procedures continue to play vital roles in the treatment of morbid obesity. The decision on which approach to use should always be made through careful consideration of the patient’s specific circumstances, in consultation with a qualified healthcare provider.

As robotic technology continues to evolve, its application in obesity treatment is likely to expand, potentially revolutionising the field of bariatric surgery and offering new hope to those struggling with morbid obesity.

Benefits of Robotic Micro-Surgery for Obesity

As robotic micro-surgery continues to evolve, its application in the treatment of morbid obesity has demonstrated numerous benefits over traditional surgical approaches. These advantages span from enhanced surgical precision to improved patient outcomes, making robotic-assisted procedures an increasingly attractive option for both surgeons and patients grappling with severe obesity[15].

Minimally Invasive Nature

One of the primary benefits of robotic micro-surgery in obesity treatment is its minimally invasive nature. This approach offers several advantages:

Smaller Incisions: Robotic-assisted bariatric procedures typically require only a few small incisions, as opposed to the large incision needed for open surgery. For instance, a robotic-assisted gastric bypass can often be performed through incisions as small as 8-12 mm.
Reduced Scarring: The smaller incisions result in less visible scarring post-surgery. This cosmetic benefit can be particularly important for patients, contributing to improved body image and psychological well-being following significant weight loss.
Faster Recovery Times: With less trauma to the abdominal wall, patients typically experience less postoperative pain and quicker recovery. Many patients undergoing robotic-assisted bariatric procedures can return home within 1-2 days post-surgery, compared to longer hospital stays for open procedures[3].

Improved Surgical Outcomes

Robotic micro-surgery offers several advantages that can lead to improved outcomes in obesity treatment:

Enhanced Precision: The robotic system’s ability to scale surgeon movements and eliminate hand tremors allows for extremely precise tissue manipulation. This precision is particularly crucial in creating gastric pouches and performing anastomoses in procedures like Roux-en-Y gastric bypass.

Reduced Complications: Studies have shown that robotic-assisted bariatric surgeries may lead to lower rates of certain complications. For example, the enhanced visualisation and precision can help reduce the risk of anastomotic leaks, a serious complication in gastric bypass surgery[9].
Better Weight Loss Results: While long-term data is still being gathered, some studies suggest that patients undergoing robotic-assisted bariatric procedures may experience slightly better weight loss outcomes compared to traditional laparoscopic approaches. This could be due to the more consistent and precise creation of gastric pouches and anastomoses[16].

Potential for Outpatient Procedures

The minimally invasive nature of robotic micro-surgery, combined with enhanced surgical precision, is paving the way for outpatient bariatric procedures. This shift towards same-day discharge for select patients undergoing robotic-assisted sleeve gastrectomy or gastric bypass represents a significant advancement in obesity treatment.

Outpatient procedures offer several benefits:

1.Reduced Healthcare Costs: By eliminating overnight hospital stays, outpatient procedures can significantly reduce the overall cost of bariatric surgery.

Improved Patient Satisfaction: Many patients prefer recovering in the comfort of their own homes, which can contribute to better overall satisfaction with the surgical experience.

Decreased Risk of Hospital-Acquired Infections: Shorter hospital stays reduce the risk of patients contracting hospital-acquired infections, a concern particularly relevant for patients with obesity who may have compromised immune systems.

Enhanced Surgeon Experience

While the focus is often on patient benefits, robotic micro-surgery also offers advantages for surgeons:

Improved Ergonomics: The seated position at the robotic console reduces physical strain during long procedures, potentially allowing surgeons to perform more operations with less fatigue.
Advanced Training Opportunities: Robotic systems often include simulation modules, allowing surgeons to practice and refine their skills in a virtual environment before operating on patients.

It’s important to note that while robotic micro-surgery offers many benefits, it may not be the best option for every patient. Alternative approaches to obesity treatment, including traditional laparoscopic procedures and non-surgical interventions, continue to play crucial roles. The choice of treatment should always be made on an individual basis, considering factors such as the patient’s overall health, BMI, and personal preferences[5].

As technology continues to advance and more long-term data becomes available, the benefits of robotic micro-surgery in obesity treatment are likely to become even more pronounced, potentially reshaping the landscape of bariatric care.

Challenges and Limitations

While robotic micro-surgery has shown promising results in the treatment of morbid obesity, it is not without its challenges and limitations. As with any emerging technology in the medical field, it’s crucial to critically evaluate these aspects to ensure the best possible outcomes for patients undergoing bariatric procedures[17].

High Initial Costs of Robotic Systems

One of the most significant challenges facing the widespread adoption of robotic micro-surgery in obesity treatment is the high initial cost of the robotic systems:

Equipment Expenses: The da Vinci Surgical System, the most commonly used robotic platform for bariatric procedures, can cost between £1.5 to £2 million. This substantial investment can be prohibitive for many healthcare facilities, particularly smaller hospitals or clinics.
Maintenance Costs: Beyond the initial purchase, robotic systems require regular maintenance and occasional repairs, which can add significant ongoing expenses
Disposable Instrument Costs: Many of the instruments used in robotic surgeries are designed for limited use, adding to the per-procedure cost.

These high costs can potentially limit access to robotic bariatric procedures, making them available primarily at large, well-funded medical centres. This disparity in access raises concerns about healthcare equity, particularly for patients with severe obesity who might benefit most from these advanced surgical techniques[18].

Learning Curve for Surgeons

Robotic micro-surgery requires a unique set of skills that differ from both open and traditional laparoscopic techniques:

Training Time: Surgeons must undergo extensive training to become proficient in using robotic systems. This training period can be lengthy, potentially delaying the implementation of robotic programmes in some hospitals.
Case Volume Requirements: To maintain proficiency, surgeons need to perform a certain number of robotic procedures regularly. This can be challenging in smaller hospitals or areas with lower patient volumes.
Team Training: Effective robotic surgery requires not just a trained surgeon, but a well-coordinated team familiar with the robotic system and its unique requirements.

The learning curve can initially lead to longer operative times, which may increase costs and potentially impact patient outcomes during the early phase of a surgeon’s robotic experience[19].

Current Technological Limitations

Despite its advanced nature, robotic micro-surgery still faces some technological limitations:

Lack of Haptic Feedback: Current robotic systems do not provide tactile sensation to the surgeon, which can be crucial in certain aspects of bariatric procedures, such as assessing tissue tension during anastomosis creation.
System Failures: Although rare, technical malfunctions can occur, potentially leading to procedure delays or conversions to traditional laparoscopic or open approaches.
Limited Instrumentation: While robotic instrumentation continues to evolve, there are still some specialized instruments used in bariatric surgery that have not been adapted for robotic use.

Potential for Over-Reliance on Technology

As robotic systems become more advanced, there’s a potential risk of over-reliance on technology:

Skill Maintenance: Surgeons heavily reliant on robotic assistance might see a decline in their skills in traditional surgical techniques, which could be problematic if a conversion to open surgery becomes necessary.
Critical Decision Making: While robotic systems enhance precision, they don’t replace the need for sound surgical judgment. There’s a risk that less experienced surgeons might rely too heavily on the technology rather than developing critical decision-making skills.

Limited Long-Term Data

While short-term outcomes of robotic bariatric surgery are promising, long-term data is still limited:

Weight Loss Outcomes: More extended follow-up studies are needed to definitively compare long-term weight loss outcomes between robotic and traditional laparoscopic approaches.
Cost-Effectiveness: The long-term cost-effectiveness of robotic bariatric surgery compared to other approaches needs further study, especially considering the high initial and ongoing costs[20].

It’s important to note that while these challenges exist, they do not negate the potential benefits of robotic micro-surgery in obesity treatment. Many of these limitations are being actively addressed through ongoing research and technological development.

For patients considering bariatric surgery, it’s crucial to discuss all available options with a healthcare provider. Alternatives to robotic gastric bypass, including traditional laparoscopic procedures and non-surgical interventions, may be more appropriate depending on individual circumstances[5].

As the field of robotic surgery continues to evolve, it’s likely that many of these challenges will be overcome, further enhancing the role of robotic micro-surgery in the treatment of morbid obesity.

Future Prospects

As robotic micro-surgery continues to evolve, its future in the treatment of morbid obesity looks increasingly promising. Ongoing research and technological advancements are paving the way for more sophisticated, efficient, and accessible robotic systems, potentially revolutionising the field of bariatric surgery[21].

Ongoing Research and Development

The landscape of robotic micro-surgery is rapidly changing, with several key areas of research and development:

Improved Haptic Feedback: One of the current limitations of robotic systems is the lack of tactile sensation for surgeons. Research is underway to develop haptic feedback technology that would allow surgeons to ‘feel’ the tissues they’re manipulating, potentially enhancing precision in procedures like gastric bypass.
Miniaturisation: Efforts are being made to create smaller, more compact robotic systems. This could potentially reduce costs and make robotic surgery more accessible to smaller hospitals and clinics.
Single-Incision Platforms: Advanced single-port robotic systems are being developed, which could allow complex bariatric procedures to be performed through a single small incision, further reducing invasiveness.
Enhanced Imaging Technologies: Integration of advanced imaging techniques, such as fluorescence imaging, could provide surgeons with real-time, detailed views of anatomical structures during obesity surgeries.

Potential for AI Integration in Robotic Surgery

Artificial Intelligence (AI) holds significant promise for enhancing robotic micro-surgery in obesity treatment:

Surgical Planning: AI algorithms could analyse patient data to help surgeons plan the most effective approach for each individual case of severe obesity.
Intraoperative Guidance: AI systems could provide real-time guidance during procedures, potentially alerting surgeons to potential complications or suggesting optimal techniques based on vast databases of previous surgeries.
Automated Tasks: In the future, AI might be able to perform certain routine aspects of bariatric procedures autonomously, under the supervision of a human surgeon.
Predictive Analytics: AI could help predict patient outcomes based on a multitude of factors, potentially improving patient selection and personalising post-operative care[22].

Expanding Applications Beyond Current Procedures

As robotic technology becomes more sophisticated, its applications in obesity treatment are likely to expand:

Novel Bariatric Procedures: Robotic systems could enable the development of new, innovative bariatric procedures that are currently not feasible with traditional laparoscopic techniques.
Revision Surgeries: With improved precision and visualisation, robotic systems could become the preferred method for complex revision surgeries following initial weight loss procedures.
Metabolic Surgeries: As our understanding of the metabolic aspects of obesity grows, robotic systems could be used to perform increasingly precise metabolic surgeries targeting specific hormonal pathways.

Increased Accessibility and Adoption

As robotic technology matures, several factors could contribute to its increased accessibility:

Cost Reduction: With more companies entering the market and production scaling up, the cost of robotic systems is likely to decrease over time, making them more accessible to a wider range of healthcare providers.
Improved Training Programs: The development of more sophisticated simulation systems and standardised training programs could help address the current learning curve challenges, potentially speeding up adoption rates.
Telesurgery: Advancements in robotic technology and telecommunications could make remote surgery a reality, potentially bringing expert surgical care to underserved areas[23].

Integration with Other Technologies

The future of robotic micro-surgery in obesity treatment is likely to involve integration with other cutting-edge technologies:

Virtual and Augmented Reality: These technologies could enhance surgical planning and provide immersive training experiences for surgeons learning robotic techniques.
3D Printing: Patient-specific 3D printed models could be used for pre-operative planning in complex bariatric cases.
Nanotechnology: In the more distant future, integration with nanotechnology could allow for even more precise and minimally invasive obesity treatments.

While these prospects are exciting, it’s important to remember that robotic surgery is just one tool in the fight against obesity. Non-surgical alternatives and traditional surgical approaches will continue to play crucial roles. The choice of treatment should always be based on individual patient needs and circumstances[5].

As we look to the future, it’s clear that robotic micro-surgery has the potential to significantly advance the treatment of morbid obesity. However, realising this potential will require continued research, technological innovation, and careful evaluation of outcomes to ensure that these advancements truly benefit patients struggling with severe obesity[24].

Ethical and Societal Implications

As robotic micro-surgery continues to advance in the treatment of morbid obesity, it brings with it a host of ethical and societal implications that must be carefully considered. These considerations extend beyond the operating room, touching on issues of healthcare equity, patient privacy, and the evolving nature of the doctor-patient relationship[25].

Accessibility and Healthcare Equity

The introduction of robotic micro-surgery in obesity treatment raises important questions about healthcare accessibility and equity:

Cost Barriers: The high cost of robotic systems and procedures may limit their availability to affluent patients or well-funded healthcare facilities. This could potentially exacerbate existing healthcare disparities, particularly in the treatment of severe obesity, which often disproportionately affects lower-income populations.
Geographic Disparities: Robotic systems are likely to be concentrated in urban medical centres, potentially leaving rural patients with limited access to these advanced treatments for morbid obesity.
Insurance Coverage: As robotic gastric bypass and other bariatric procedures become more common, questions arise about insurance coverage. Will these procedures be covered equitably, or will they become a luxury reserved for those who can afford to pay out-of-pocket?

To address these concerns, policymakers and healthcare providers must work together to ensure that the benefits of robotic micro-surgery in obesity treatment are accessible to all who need them, regardless of socioeconomic status or geographic location[26].

Patient Privacy and Data Security

The use of robotic systems in bariatric surgery introduces new challenges related to patient privacy and data security:

Data Collection: Robotic systems collect vast amounts of data during surgeries, including video footage and detailed operational metrics. This raises questions about how this data is stored, who has access to it, and how it might be used.
Cybersecurity Risks: As robotic systems become more connected and data-driven, they may become targets for cyberattacks. Ensuring the security of these systems is crucial to protect patient safety and privacy.
Informed Consent: Patients undergoing robotic bariatric procedures must be fully informed about what data is collected during their surgery and how it will be used. This adds a new dimension to the informed consent process.

Changing Doctor-Patient Relationships

The integration of robotic technology in obesity treatment has the potential to alter the traditional doctor-patient relationship:

Physical Distance: With the surgeon operating from a console rather than standing over the patient, there’s a physical separation that could impact the personal connection between doctor and patient.
Team Dynamics: Robotic surgery requires a team approach, potentially changing the dynamics of surgical care and how patients interact with their healthcare providers.
Trust in Technology: Patients must not only trust their surgeon but also the robotic technology being used. This requires clear communication and education about the role of robotics in their care.

Ethical Considerations in Technological Advancement

As robotic micro-surgery continues to evolve, several ethical considerations come to the forefront:

Balancing Innovation and Patient Safety: There’s an ethical imperative to innovate and improve surgical techniques for obesity treatment. However, this must be balanced against the need to ensure patient safety, particularly as new robotic technologies are introduced.
Equitable Distribution of Resources: With limited healthcare resources, there are ethical questions about the allocation of funds for expensive robotic systems versus other obesity treatments or healthcare needs.
Responsibility and Liability: As robotic systems become more autonomous, questions arise about who is responsible in case of errors – the surgeon, the hospital, or the manufacturer of the robotic system?

Societal Perceptions and Stigma

The advancement of robotic micro-surgery in obesity treatment may also impact societal perceptions of obesity and its treatment:

Medicalization of Obesity: The increasing sophistication of surgical treatments for obesity could potentially reinforce the view of obesity as a purely medical condition, potentially overshadowing important social and environmental factors.
Stigma and Discrimination: While advanced surgical options may help some individuals with obesity, there’s a risk that it could inadvertently increase stigma against those who don’t pursue or don’t have access to these treatments.

It’s crucial to remember that while robotic micro-surgery represents an exciting advancement in obesity treatment, it’s not a panacea. Non-surgical alternatives and comprehensive lifestyle interventions remain vital components of obesity management[5].

As we navigate these ethical and societal implications, it’s essential to maintain a patient-centered approach, ensuring that technological advancements in obesity treatment serve to improve patient care and quality of life, rather than exacerbate existing healthcare disparities or ethical dilemmas[27, 28].

World Health Organization. (2021). “Obesity and overweight”. *WHO Fact Sheets*.
Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2020). “Prevalence of obesity and severe obesity among adults: United States, 2017-2018”. *NCHS Data Brief*, (360), 1-8.
Bindal, V., Bhatia, P., Dudeja, U., Kalhan, S., Khetan, M., John, S., & Wadhera, S. (2015). “Review of contemporary role of robotics in bariatric surgery”. *Journal of Minimal Access Surgery*, 11(1), 16-21.
Intuitive Surgical. (2021). “da Vinci Surgery for Bariatric Procedures”. *Intuitive Surgical Website*.
National Institute of Diabetes and Digestive and Kidney Diseases. (2020). “Types of Bariatric Surgery”. *NIDDK*.
Jayne, D., Pigazzi, A., Marshall, H., Croft, J., Corrigan, N., Copeland, J., … & Brown, J. (2017). “Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial”. *JAMA*, 318(16), 1569-1580.
Cadière, G. B., Himpens, J., Vertruyen, M., Bruyns, J., Germay, O., Leman, G., & Izizaw, R. (2001). “First telerobotic remote gastric bypass: Feasibility study”. *Surgical Endoscopy*, 15(9), 918-923.
Hagen, M. E., Pugin, F., Chassot, G., Huber, O., Buchs, N., Iranmanesh, P., & Morel, P. (2012). “Reducing cost of surgery by avoiding complications: the model of robotic Roux-en-Y gastric bypass”. *Obesity Surgery*, 22(1), 52-61.
Snyder, B., Wilson, T., Leong, B. Y., Klein, C., & Wilson, E. B. (2013). “Robotic-assisted Roux-en-Y gastric bypass: minimizing morbidity and mortality”. *Obesity Surgery*, 23(6), 777-784.
Elli, E. F., Gonzalez-Heredia, R., Sarvepalli, S., & Masrur, M. (2015). “Robotic and laparoscopic Roux-en-Y gastric bypass: review and comparison of outcomes”. *Obesity Surgery*, 25(11), 2180-2185.
Buchs, N. C., Morel, P., Azagury, D. E., Jung, M., Chassot, G., Huber, O., … & Hagen, M. E. (2014). “Laparoscopic versus robotic Roux-en-Y gastric bypass: lessons and long-term follow-up learned from a large prospective monocentric study”. *Obesity Surgery*, 24(12), 2031-2039.
Magouliotis, D. E., Tasiopoulou, V. S., Sioka, E., Chatedaki, C., & Zacharoulis, D. (2018). “Robotic versus laparoscopic sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis”. *Obesity Surgery*, 28(11), 3385-3392.
Intuitive Surgical. (2021). “EndoWrist Instruments”. *Intuitive Surgical Website*.
Konstantinidis, K. M., Hirides, P., Hirides, S., Chrysocheris, P., & Georgiou, M. (2012). “Cholecystectomy using a novel Single-Site® robotic platform: early experience from 45 consecutive cases”. *Surgical Endoscopy*, 26(9), 2687-2694.
Curry, T. W. (2019). “Robotic Bariatric Surgery: A Systematic Review”. *Bariatric Times*, 16(6), 16-18.
Beckmann, J. H., Ahnert, P., Berreth, F., Aghajani, E., Schlensak, C., & Königsrainer, A. (2020). “Robotic-assisted gastric bypass surgery: a systematic review”. *Obesity Surgery*, 30(12), 4942-4950.
Familiari, P., Ricci, G., Boskoski, I., Giannone, F., & Costamagna, G. (2020). “Robotic bariatric surgery: a systematic review”. *Obesity Surgery*, 30(2), 732-744.
Bhandari, M., Humes, D. J., West, M. A., & Lobo, D. N. (2021). “Robotic versus laparoscopic surgery for obesity and gastrointestinal cancer”. *British Journal of Surgery*, 108(8), 865-873.
Higgins, R. M., Frelich, M. J., Bosler, M. E., & Gould, J. C. (2017). “Cost analysis of robotic versus laparoscopic general surgery procedures”. *Surgical Endoscopy*, 31(1), 185-192.
Toro, J. P., Lin, E., & Patel, A. D. (2015). “Review of robotics in foregut and bariatric surgery”. *Surgical Endoscopy*, 29(1), 1-8.
Alhossaini, R. M., Altamran, A. A., Bunt, J. C., & Podetta, M. (2021). “Robotic bariatric surgery: The next frontier in minimally invasive surgery”. *Journal of Robotic Surgery*, 15(4), 545-553.
Hashimoto, D. A., Rosman, G., Rus, D., & Meireles, O. R. (2018). “Artificial intelligence in surgery: promises and perils”. *Annals of Surgery*, 268(1), 70-76.
Salmeron-Rodriguez, M. D., & Gonzalez-Rivas, D. (2020). “Future of robotic surgery: ambulatory, office-based, and long-distance surgery”. *Annals of Translational Medicine*, 8(11), 736.
Choi, J. Y., & Cho, Y. S. (2021). “Current status and future perspective of robotic surgery in gastric cancer”. *Translational Gastroenterology and Hepatology*, 6, 32.
Bove, A. A., & Nilsson, P. M. (2020). “Health equity: New perspectives for clinical practice”. *European Journal of Internal Medicine*, 75, 1-7.
Patti, J. C., & Heidrich, S. M. (2019). “Ethical issues in the care of patients with obesity”. *Nursing Clinics*, 54(1), 131-143.
Abeles, D., & Sivashanker, K. (2019). “Ethical considerations and implications of robotic surgery”. *Current Opinion in Urology*, 29(6), 611-615.
Saeidi, N., Arabi, M., & Saidi, R. F. (2021). “Ethical considerations in robotic surgery”. *Journal of Robotic Surgery*, 15(1), 1-5.

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