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surgical intervention video

This is the case of a 62-year old female patient with a BMI of 35 and a history of high blood pressure, dyslipidemia, and morbid obesity. She underwent a laparoscopic Nissen surgery 8 years earlier and presented with recurrent GERD symptoms. 



A CT-scan, an endoscopy, and a barium swallow showed a hiatal hernia. It was decided to perform a paraesophageal hernia repair as well as a gastric bypass. A laparoscopic surgery was performed.



There were no complications and the patient was discharged on the second postoperative day. An esogastroduodenal contrast examination was performed 1 month after the procedure. It showed the absence of hiatal hernia. The patient was controlled 3 months after surgery and was found asymptomatic with an Excess Weight Loss (EWL) of 42%.

Laparoscopic Roux-en-Y gastric bypass (RYGB) after failed Nissen

Pontage gastrique Roux-en-Y laparoscopique après l'échec d'un Nissen


Лапароскопиеское шунтирование желудка по Ру после неудачной фундопликации по Ниссену

Bypass gástrico em Y de Roux laparoscópico (BGYRL) após Nissen malsucedido


Bypass gástrico en Y de Roux laparoscópico (BGYRL) después de Nissen fallido


腹腔镜Roux-en-Y胃绕道手术（RYGB）失败Nissen后


There are only a few descriptions of laparoscopic Roux-en-Y gastric bypass (LRYGB) in the setting of intestinal malrotation and these are limited to clinical case reports. Intestinal malrotations usually present in the first months of life with symptoms of bowel obstruction. However, in rare cases, it can persist undetected into adulthood when it could be incidentally identified. The anatomical abnormalities which should alert us to this possibility are an absent duodenojejunal angle, the small bowel on the right side of the abdomen, the caecum on the left, and the absence of a transverse colon crossing the abdomen. Identification and adjustment of the surgical technique at the time of laparoscopic Roux-en-Y gastric bypass (RYGB) is crucial to prevent a very distal RYGB or avoid confusion between the Roux limb and the common channel. The construction of the laparoscopic Roux limb can be safely performed with adjustments to the standard technique. 

We present the case of a 45-year-old woman with a long history of morbid obesity, hypertension, and hyperlipidemia. The patient had no complaints and presented a normal preoperative evaluation. After a multidisciplinary evaluation, she was elected to undergo a LRYGB. We report an intestinal malrotation discovered at the time of LRYGB, and detail the incidental findings and the technical aspects which require to be incorporated in order to complete the operation safely. 

Laparoscopic gastric bypass with unexpected intestinal malrotation

腹腔镜胃旁路术，出现意外肠扭转


Bypass gástrico laparoscópico com malrotação inesperada do intestino


Bypass gástrico laparoscópico con malrotación inesperada del intestino


Лапароскопическое шунтирование желудка с непредвиденной кишечной недостаточностью

Pontage gastrique laparoscopique avec malrotation intestinale inattendue 


Minimally invasive surgery is a field of continuous evolution and the advantages of this approach is no longer a matter of debate. The laparoscopic Roux-en-Y gastric bypass (LRYGB) has shown to be the cornerstone in the treatment of morbid obesity and so far all the efforts in this technique have been conducted to demonstrate safety and efficacy. Nowadays, reduced port surgery is regaining momentum as the evolution of minimally invasive surgery. 

The purpose is to describe our technique of LRYGB, which mimics all the fundamental aspects of the “simplified gastric bypass” described by A. Cardoso Ramos et al. in a conventional laparoscopic surgical approach (5 ports) while incorporating some innovative technical features to reduce the quantity of ports. Despite the use of only three trocars, there is no problem with exposure or ergonomics, which represent major drawbacks when performing reduced port surgery.



Our technique can be a useful and feasible tool in selected patients in order to minimize parietal trauma and its possible complications, to improve cosmetic results, and to indirectly avoid the need for a second assistant, thereby improving the logistics, team dynamics, and economic aspects of the procedure. 



In our experience, this technique is indicated as primary surgery in patients without previous surgery and with a BMI ranging from 35 to 50. Major contraindications are liver steatosis, superobese patients, and potentially revisional surgery. Although based on the experience of the team, we had also to perform revisional surgery mostly from ring vertical gastroplasty. 



From January 2015 to June 2017, we analyzed 72 consecutive cases in our institution with a mean initial BMI of 43.12 (range: 30.1-58.7) using this approach, and the mean operative time was 64.77 minutes (range: 30-155, n=72) and excluding revisional cases or cases associated with cholecystectomy (58.72 min, range: 30-104, n=62). 



This approach should be performed by highly skilled surgeons experienced with conventional Roux-en-Y gastric bypass and with one of the patients feeling particularly comfortable. We strongly suggest using additional trocars if patient safety is jeopardized.



Advanced bariatric surgery: reduced port simplified gastric bypass, a reproducible 3-port technique

Chirurgie bariatrique avancée: pontage gastrique avec trocart réduit, une technique reproductible à 3 trocarts


先进的减肥手术：减少了港口简化胃旁路，一个可重复的三端口技术


Бариатрическая хирургия: упрощённое шунтирование желудка с использованием трёх портов 

Cirurgia bariátrica avançada: bypass gástrico simplificado com portais reduzidos, uma técnica reproduzível de três portais


Cirugía bariátrica avanzada: bypass gástrico simplificado con puertos reducidos, una técnica reproducible de tres puertos


Bypass gastrique laparoscopique avec anastomose circulaire


Лапароскопическое шунтирование желудка по Ру с формированием циркулярного анастомоза 


This video presents a live demonstration of a laparoscopic Roux-en-Y gastric bypass with a variation in the technique of performing gastrojejunostomy with a circular stapling device and performing jejunojejunostomy with a linear stapler exclusively. 

Laparoscopic Roux-en-Y gastric bypass with circular anastomosis

Лапароскопическое шунтирование желудка по Ру: техника двойного сшивания и формирование линейного анастомоза


Bypass gastrique laparoscopique : technique double loop et anastomose linéaire


In this didactic live video, Dr. Cardoso Ramos presents a conventional laparoscopic gastric bypass procedure in a 37-year-old woman with a BMI of 41. He briefly describes the technical aspects, maneuvers, the main principles, and key steps of the surgical procedure in a live interactive session. He also takes into account the importance of a tailor-made surgical procedure based on the patient’s characteristics.

Laparoscopic Roux-en-Y gastric bypass: double loop technique and linear anastomosis

This video presents the case of a morbidly obese female patient with a past surgical history of a gastric banding in 2006 and sleeve gastrectomy in 2009. Once again, after completing the sleeve dissection and evaluating the case, the laparoscopic gastric bypass turns out to be the strategy of choice as a redo surgery. Dr. Higa shows his dexterity and command of all technical steps while performing a handsewn single layer interrupted gastrojejunal anastomosis. 



Conversion from laparoscopic sleeve gastrectomy to laparoscopic Roux-en-Y gastric bypass: redo procedure

Конверсия после лапароскопической рукавной гастрэктомии к лапароскопическому шунтированию желудка по Ру: повторная процедура


Conversion d'une sleeve gastrectomie laparoscopique en un bypass gastrique laparoscopique : reprise de chirurgie


Bypass gastrique robotique entièrement suturée manuellement : intervention live


Ручное формирование анастомоза по Ру: демонстрация в режиме реального времени


This video presents a live demonstration of a robotic Roux-en-Y gastric bypass during which the gastrojejunal anastomosis was fully handsewn and performed taking advantage of the stability and wide range of motion offered by the robotic surgery platform.

Full handsewn robotic Roux-en-Y gastric bypass: live demonstration

This video presents a live demonstration of a robotic sleeve gastrectomy using the da Vinci Xi™ robotic surgical platform. The docking of the platform, the positioning of ports, and the use of the mechanical stapling instrument (EndoWrist® Stapler) and coagulation system (Vessel Sealer™) are demonstrated. 

Live robotic sleeve gastrectomy 

Роботизированная рукавная гастрэктомия в режиме реального времени


Sleeve gastrectomie robotique live


Sleeve gastrectomie robotique


Роботизированная рукавная гастрэктомия


In this video, we present the performance of a robot-assisted sleeve gastrectomy with emphasis on the advantages offered by the robotic platform in terms of image stability, reduction of unnecessary movements, and increase in the articulation ranges of surgical instruments.

Robotic sleeve gastrectomy 

Bypass gastrique entièrement robotique


Полностью роботизированное шунтирование желудка по Ру в режиме реального времени


In this video, we present the performance of a robotic Roux-en-Y gastric bypass with emphasis on the advantages offered by the robotic platform in terms of image stability, reduction of unnecessary movements, and increased articulation ranges of surgical instruments.

Full robotic Roux-en-Y gastric bypass 

This video presents a laparoscopic sleeve gastrectomy and its pitfalls in a 31-year-old male patient with a BMI of 43.

Laparoscopic sleeve gastrectomy

Sleeve gastrectomie laparoscopique


Лапароскопическая рукавная гастрэктомия


video lecture

Empêcher le saignement postopératoire après la chirurgie bariatrique


In this key lecture, Dr. Copaescu addresses the means of prevention of postoperative bleeding after bariatric surgery. 

Preventing postoperative bleeding after bariatric surgery

Предотвращение послеоперационного кровотечения после бариантрической операции


Nesta palestra magistral, o Dr. Copaescu aborda os meios de prevenção do sangramento pós-operatório após cirurgia bariátrica.


Prevenindo o sangramento pós-operatório após cirurgia bariátrica

In this authoritative lecture, Dr. Higa addresses trends in bariatric surgery: what is the state-of-the-art?

Trends in bariatric surgery: what is the state-of-the-art?

Тенденции в бариатрической хирургии


Nesta palestra de especialista, o Dr. Higa aborda as tendências da cirurgia bariátrica: qual é o estado da arte?


Tendências da cirurgia bariátrica: qual é o estado da arte

Tendances en chirurgie bariatrique : quel est l'état de l'art ? 


Complications du traitement laparoscopique du pontage gastrique Roux-en-Y : ulcère perforé, candy cane, hernie interne


Nesta palestra magistral, o Dr. Michel Suter destaca o tratamento laparoscópico de complicações do bypass gástrico em Y de Roux: úlcera perfurada, candy cane e hérnia interna.


Tratamento laparoscópico de complicações do bypass gástrico em Y de Roux: úlcera perfurada, candy cane, hérnia interna

In this key lecture, Dr. Michel Suter outlines the laparoscopic treatment of Roux-en-Y gastric bypass complications, including perforated ulcer, candy cane, and internal hernia.

Laparoscopic treatment of Roux-en-Y gastric bypass complications: perforated ulcer, candy cane, internal hernia

Лапароскопическое лечение осложнений после шунтирования желудка по Ру: перфорированная язва, синдром длинной культи петли Ру, внутренняя грыжа


In this key lecture, Dr. Cardoso Ramos considers reversal to normal anatomy in a Roux-en-Y gastric bypass.

Roux-en-Y gastric bypass (RYGB): reversal to normal anatomy

Nesta palestra magistral, o Dr. Cardoso Ramos considera a reversão à anatomia normal no bypass gástrico em Y de Roux.


Aypass gástrico em Y de Roux (BGYR): reversão à anatomia normal

Шунтирование желудка по Ру: переход к нормальной анатомии


Pontage gastrique Roux-en-Y : retour à une anatomie normale


Pontage gastrique : est-ce une procédure standard ou devrions-nous utiliser d'autres techniques ? 


In this key lecture, Dr. Higa focuses on gastric bypass and considers the following issue: do surgeons have a gold standard or should they consider other techniques?

Gastric bypass: do we have a gold standard or should we consider other techniques?

Nesta palestra magistral, o Dr. Higa se concentra no bypass gástrico e considera a seguinte questão: os cirurgiões têm um padrão-ouro ou deveriam considerar outras técnicas?


Bypass gástrico: temos um padrão-ouro ou devemos considerar outras técnicas?

Шунтирование желудка: классический подход или другие методы?


In this key lecture, Dr. Laurent Brunaud compares robotic bypass with laparoscopic bypass.

Robotic bypass vs. laparoscopic bypass

Роботизированное vs. лапароскопическое шунтирование желудка


Pontage robotique vs. Pontage laparoscopique


Nesta palestra magistral, o Dr. Laurent Brunaud compara o bypass robótico com o bypass laparoscópico.


Bypass robótico vs. bypass laparoscópico

Nesta palestra magistral, o Dr. Leon Katz se concentra na robótica na cirurgia da obesidade.


Robótica na cirurgia da obesidade

Робототехника в хирургическом лечении ожирения


La robotique pour la chirurgie de l'obésité


In this key lecture, Dr. Leon Katz focuses on robotics in obesity surgery.

Robotics in obesity surgery

Gastrectomie sleeve robotique : technique et dangers


In this key lecture, Dr. Luiz Alfredo Vieira d'Almeida outlines the robotic sleeve gastrectomy technique along with its associated pitfalls.

Robotic sleeve gastrectomy: technique and pitfalls

Nesta palestra magistral, o Dr. Luiz Alfredo Vieira d'Almeida destaca a técnica da gastrectomia vertical junto com suas armadilhas associadas.


Gastrectomia vertical robótica: técnica e armadilhas

Роботизированная рукавная гастрэктомия: методы и типичные ошибки


In this key lecture, Dr. Luiz Alfredo Vieira d'Almeida outlines the robotic assisted gastric bypass technique.

Robotic gastric bypass: technique

Nesta palestra magistral, o Dr. Luiz Alfredo Vieira d'Almeida destaca a técnica do bypass gástrico assistido por robô.


Bypass gástrico robótico: técnica

Pontage gastrique robotique : technique


Роботизированное шунтирование желудка: методы


Следующий шаг в робототехнике


Les prochaines étapes en robotique 


In this key lecture, Dr. Keith Kim addresses the next steps in robotics.

Next steps in robotics

Nesta palestra magistral, o Dr. Keith Kim aborda os próximos passos na robótica.


Próximos passos na robótica

Преимущества роботизированной платформы в ревзионной хирургии


Bénéfices de la plateforme robotique en chirurgie révisionnelle


In this key lecture, Dr. Keith Kim highlights the benefits of the robotic platform in revisional surgery.

Benefits of the robotic platform in revisional surgery

Nesta palestra magistral, o Dr. Keith Kim destaca os benefícios da plataforma robótica na cirurgia de revisão.


Benefícios da plataforma robótica para a cirurgia de revisão

Gastrectomie sleeve : fuites et fistules 


Nesta palestra magistral, o Dr. Gianfranco Donatelli remete aos problemas de extravasamentos e fístulas na gastrectomia vertical.


Gastrectomia vertical: extravasamentos e fístulas

Рукавная гастрэктомия: подтёки т свищи


In this key lecture, Dr. Gianfranco Donatelli addresses the issues of leaks and fistulas in sleeve gastromy.

Bariatric Surgery, Laparoscopic Vs. Robotic Approaches