6min), selleck Cisplatin which represented the mastery phase, with a decrease in OT (P = 0.0001) [14]. However there could be a phase three, a phase four, or even beyond as in our case series. His mean operative time of 223.6min for phase 2 (his defined mastery phase), which is considerably longer than typical operative times for robotic gastric bypass, makes it very likely that there are more stabilization points in operative time. For this reason, we have to comment that we could have a sample size too small to capture this stabilization phenomenon. However, times and result in terms of complications, outcomes, and results are satisfactory. When discussing robotics, all authors are concerned about time. It is clear that time can be a major issue in robotic surgery.

For this reason, we focused specifically on the set-up and docking times of the da Vinci surgical system in order to perform surgery efficiently. According to our data, trained nurses can achieve robotic setup efficiently, and docking can be conducted time effectively by the console surgeon and the first assistant. As shown previously, a trained nurse can complete robotic draping within 35 minutes while the patient is in preparation for anesthesia. The learning curve for docking has been successfully completed in our experience. Some authors have observed an increase in operating time when using the robotic system, but we believe that a learning curve is required in order to decrease time loss and potential risks [15�C17].

To our knowledge the only previous report of robotic sleeve gastrectomy mentioned the advantages of using this procedure instead of a robotic gastric bypass (RGBP) as the first step to introducing robotic surgery to a bariatric unit [18]. They suggested, and we agree, that it is always wiser to start with a less demanding procedure in order to avoid errors in the initial phases of the overall robotic learning curve. In this paper, no data were reported concerning the learning curve before attempting to undergo a RYGBP. In our experience, and according to our protocol, we perform sleeve gastrectomy in superobese patients (BMI > 50) and we consider it more suitable for initial robotic training. Using robotic assisted techniques, even in part, could be considered in RYGBP during a learning curve instead of reinforced staple line RSG. Robotic assisted RYGBP was recently performed effectively in more than 300 patients [19].

However, we suggest that RSG be completed before RYGBP Entinostat is introduced to routine clinical practice within a bariatric unit. 5. Conclusion Our early experience in RSG suggests that robotic surgery is safe, feasible, and could be an effective alternative to the conventional laparoscopic approach in bariatric surgery. Robotic surgery gives all the benefits of the laparoscopic approach, with added benefits in certain challenging surgical cases. However, we believe that bariatric surgeons should be trained in RSG before RYGBP.