Page Bari Notes
Robot RNY - Page
Consider shipping out bmi > 60 - higher complication rate and fewer resources
Semi circle
8, 12w reducer in it, 8, 8, 8
Assistant suction, Cadiere, scope, vessel sealer, cadiere
Head up 23 degrees, liver retractor
Left crus exposed
30cc balloon
Pars flaccida window
Retrogastric dissection
• Hug posterior stomach and bluntly dissect your way through and take some w vessel sealer
Blue load - or white if small
• Big blade posterior and fire transversely
Cont retrogast dissection toward left crus w vessel sealer
3 staple load to transect stomach
• Clear off posterior pouch - watch out for L gastric (supplies pouch)
Remove air from ballon and pull back
0 to 5 degrees - flat if you need to
Divide omentum
Grab epiploica and lift toward head w vessel sealer
Identify site 50-60cm from LOT
Go back up to 23 degrees
Don’t transect yet
Take up to pouch with the help of stratifix PDS
Stratafix PDS posterior wall
Indocyanine green 2mL takes 2 minutes before dividing
Transect small bowel for perfect candy cane length and blood flow - white load
Bring deflated ballon to pouch tip
Gastrotomy pull ballon through and rip it
jejunotomy
Inner vicryl posterior purple, anterior white
Before completing, bring G tube into jejunum
Complete outer stratifix layer with a separate suture
Back to 23 degrees head up
Measure 100 on roux limb
Secure both limbs with vicryl
Enterotomies
White load anastomosis
Vicryl to close enterotomy
Silk brolin stitch - anti twist stitch — basically just close JJ defect
Leak test - clamp bowel, 1L/min