A Hybrid Laparoscopic-Robotic Technique for Single Anastomosis Duodeno-Ileostomy With Sleeve Gastrectomy (SADI-S): A Consecutive Case Series Demonstrating Feasibility and Early Outcomes.

INTRODUCTION: Single anastomosis duodenoileostomy with sleeve gastrectomy (SADI-S) provides durable weight loss and metabolic improvement, particularly in patients with severe obesity. Despite outcomes comparable to other metabolic and bariatric surgery procedures, its adoption has been limited by the technical complexity of duodenal mobilization and hand-sewn duodeno-ileal anastomosis.

METHODS: We describe a standardized hybrid laparoscopic-robotic approach to SADI-S developed at our institution. Laparoscopy is used for sleeve gastrectomy, bowel measurement, and initial duodenal mobilization, while robotic assistance is employed for completion of duodenal mobilization and construction of the hand-sewn duodenoileal anastomosis. A retrospective consecutive case series of 55 patients undergoing this approach between January 2022 and July 2025 is reported. Inclusion and exclusion criteria, operative steps, perioperative management, and 30-d and 3-mo outcomes are detailed. Chronological analysis of early (cases 1-25) versus late (cases 26-55) cases was performed to assess procedural trends over time.

RESULTS: All 55 procedures were completed using the planned hybrid approach without conversion to open surgery. The mean total operative time was 176 ± 28 min, including a mean robotic console time of 42 ± 11 min. There were no anastomotic leaks (0%; 95% confidence interval: 0-6.5%). The mean hospital length of stay was 1.6 ± 0.7 d with no postoperative intensive care unit admissions. Thirty-day reoperation and readmission rates were 1.8% and 3.6%, respectively. Robotic console time declined significantly between early and late cases (47 ± 12 versus 38 ± 9 min; P = 0.003). At 3-mo follow-up (available in 48 patients, 87.3%), mean %total weight loss was 21.3 ± 4.8% and partial or complete Type 2 Diabetes Mellitus remission was observed in 58.6% of diabetic patients.

CONCLUSIONS: The hybrid laparoscopic-robotic SADI-S approach is feasible and safe in experienced hands at a high-volume academic bariatric center. By reserving robotic assistance for the most technically demanding component of the operation, this strategy achieves consistent perioperative outcomes with a short hospital stay. Whether this approach confers measurable advantages over purely laparoscopic or fully robotic alternatives requires prospective comparative investigation.