Abstract Background Robotic-assisted bariatric surgery, using the da Vinci Xi, enhances stapling precision in sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB). Optimizing trocar placement, cartridge selection, and intraoperative techniques is critical to minimize complications. Methods We reviewed 140 robotic procedures (76 sleeves, 54 RYGB, 10 revision surgery March 2024–May 2025) under IRB approval, assessing operative techniques and outcomes (0% leaks, 1.6% complications). Staple lines were reinforced with robotic suturing (no buttress) on a selective basis. Practical tips were developed from clinical experience and supported by literature. Results Tips include: Position of trocars; Select cartridge and trusting the stapler intelligence (Sureform); Suture staple lines robotically with absorbable sutures (for example, V-Loc) for strength, Set up tissue for minimal manipulation before engaging with the stapler, maintain ergonomic console hand positioning, rotate stapler for even tissue engagement, verify configuration, monitor firing sound for consistency, and shape instruments during firing to maintain exposure. Some of these techniques, validated by literature and our 0% leak rate, enhance efficiency and safety. Conclusion These tips provide practical strategies for optimizing robotic stapling in bariatric surgery. They are adaptable for global use, with multicenter studies needed to confirm efficacy. This approach ensures safe, efficient outcomes in robotic sleeve and RYGB procedures.
Ramar et al. (Thu,) studied this question.