---

Robotic devices developed by companies, such as computer motion (Santa Barbara, CA) and integrated surgical systems (Davis, CA), have the potential to revolutionize surgery and the operating room. They provide surgeons with precision and dexterity, necessary to perform the complex, minimally invasive surgical (MIS) procedures, such as beating-heart single or double-vessel bypass, neurological, orthopedic, and plastic surgery. Robot will also broaden the scope and increase the effectiveness of MIS, improve patients’ outcome and create a safer and more efficient procedure (1). Today robots are used to perform high tech precise procedures and dangerous tasks in industry and research fields, which were previously not possible by a human work force alone. Robots are routinely used to manufacture microprocessors, used in computers, explore the dangerous areas of earth, and work in hazardous environment that are not possible for human being to step in. However, Robots has progressively entered the field of medicine (2). Karel Capek, the Czech Republic writer, created an artificial human; named “Robot” that was his brother’s name and means “forced labor”. Robotic system and other voice activations are the methods by which these surgical robots are controlled. Computer controlled machinery can mimic the awareness, adaptability and knowledge of a human surgeon. With the help of Robot a surgeon can control the procedure from thousands of kilometers away. Other advantages of Robotic surgery, such as 3D vision, motion scaling, fluid movement, wrist articulation capability, remote sensing technology, tremor filtering, ergonomically intuitive sensing, 25 times more magnification, multiple instruments entrance system, haptic feedback and tele-surgery with tele-proctoring (3). The first minimally invasive surgery was laparoscopic cholecystectomy performed in 1987 and laparoscopic procedures have been increasing afterwards by improvement of technology and experience of surgeons. Robotic surgery is an important issue in medicine. With Robotic the intra-abdominal access, the wrist movement, intra corporeal suturing and dissection of pelvic region will be easier than other surgical methods. The advantages of robotic surgery include restoring proper hand-eye coordination, ergonomic position, and improved visualization. However, the robotic surgery has some limitations, including disability to use qualitative information, absence of surgeons’ judgment, absence of tactile or haptic information and the high expenses. In our country minimally invasive surgery, especially bariatric surgery is being performed widely. Considering the fact that the literacy rate of our society is above 90% and most of our population is wealthy, performing the best surgical service is a right for our people and minimally invasive surgery is a great revolution in surgical field and Robotic surgery is increasing day after day. Unfortunately we cannot import Robot to our country due to unjustified sanctions and without Robotic procedure; the progress in minimally invasive surgery will also be is under question. This is a right of our nation to have access to the best surgical services. As a professional we expect to exclude the Davinci Robot from list of the sanctions (4).

---

Background

In 2005, obesity rate was declared 396 million worldwide, which has been doubled in the last 20 years (compared with 1985). Obesity has a strong correlation with a pool of comorbidities and consequences. Although many modules, including behavioural approach and medications have presented particular short-term unreliable methods to reduce and control the body weight in morbid obesity, only 5 - 10% of weight loss was achieved, which is usually regained overtime, compared with 50 - 75% success rate in bariatric surgery.

Objectives

This retrospective study tried to monitor weight loss after LRYGB and LSG in morbid obese patients referred to a known center in Tehran through a one-year follow up.

Materials and Methods

Participants were selected regarding the U.S. National Institute of Health (NIH) guidelines, which indicates BMI > 40 kg/m² alone, or BMI > 35 kg/m² in addition to comorbidities and failure of non-surgical attempts to control their weight. They were visited at points of one, three, six, and 12 months postoperatively to collect information about weight loss, BMI, and complications in addition to percent excess weight loss (EWL%). The percentage of failure was computed to the proportion of patients who had EWL% < 25 to the total number of operated patients in a year.

Results

Significant decrease in BMI and weight were achieved in all postoperative visits (for all of them, P value < 0.0001), while no significant difference was found in which the parameters between two studied procedures were in this regard.

Conclusions

To sum up, LRYGB and LSG deserve an overall preference not only in current study, but also in the majority of performances up to now. Nevertheless it is urgent the relevant studies to confirm the preference or improve this kind of bariatric surgery in order to diminish complications as far as possible.

---

Introduction

Ileal diverticulum is a rare disease that presents with complications such as diverticulitis.

Case Presentation

We present an 81-year-old man with partial small bowel obstruction having abdominal pain, nausea, vomiting for 48 hours and a mobile abdominal mass. After CT scan, exploratory laparoscopy and small bowel resection was done with primary anastomosis.

Conclusions

When adhesion, internal hernia and malignancy are ruled out in patient presenting with partial obstruction and abdominal mass, other causes like diverticula must be considered.

---

Surgical treatment of patients with morbid obesity is now the most successful way to return to active life and overcome its effects. Complications during surgery, but still are varied and plentiful. One of the most important of these effects is increased bleeding during surgery and may require further surgery is surgery duration. The use of propranolol in other operations under the impact of which is helpful in reducing blood loss in surgery Bariatric still not been investigated. The purpose of this study is the use of propranolol in reducing gastric bypass surgery is bleeding.