Introduction: The objective of the video is to demonstrate the use of the Da Vinci Robotic system in performing a hybrid robotic assisted laparoscopic Roux-en-Y gastric bypass.

Methods: 53 year old woman with a BMI of 55 presented for bariatric surgery. She was offered robotic assisted laparoscopic Roux-en-Y gastric bypass. The video presentation showcases the technique of Hand-Sewn Robotic assisted laparoscopic Roux-en-Y gastric bypass.

Results: The patient is positioned supine and the trocar set up includes a 12mm camera port, 12mm and 5mm surgeons working port, two 12mm first assistant ports on the left side of the abdomen and a Nathanson retractor for retracting the left lobe of the liver. The dissection begins by creating a 30cc gastric pouch using an endo GIA. The jejuno-jejunal anastomosis is created about 50 cm from the ligament of trietz and bypassing about 150cm of the jejunum. Using the same trocar set up, the robotic trocars are inserted into the laparoscopic trocars and the gastro-jejunal anastomosis is created by handsewn double layer technique.

Conclusion: The video highlights the technical maneuvers which a robotic system offers over the traditional laparoscopic set up.