124 Video presentation: The Kite Technique: A Novel Two-Layered Closure for Jejunojejunostomy in Robotic-Assisted Roux-en-Y Gastric Bypass

Abstract Background Robotic-assisted Roux-en-Y gastric bypass (RYGB) enhances precision in bariatric surgery, yet jejunojejunostomy (JJ) anastomosis remains a critical step prone to complications such as afferent limb obstruction. The Kite Technique, a novel two-layered closure method, was developed to improve surgical reliability and postoperative outcomes during JJ anastomosis. Method The Kite Technique involves a two-layered closure of the service antrotomy in robotic-assisted RYGB, incorporating a strategically placed anti-obstruction stitch to optimize the anatomical lie of the JJ anastomosis. This stitch minimizes tension asymmetry, reducing the risk of afferent limb obstruction. The closure’s kite-like structure ensures symmetrical tissue approximation, enhancing mechanical stability and reproducibility. The technique leverages the robotic platform’s precision and articulation for consistent execution. Results The Kite Technique has been implemented in over 50 robotic RYGB procedures from my practice, demonstrating simplicity, reproducibility, and functional safety. The anti-obstruction stitch and kite-shaped closure provide “double surety” in mechanical soundness and anatomical positioning, potentially lowering obstruction risks. Conclusions The Kite Technique offers a simple, reproducible, and safe enhancement to JJ anastomosis in robotic-assisted RYGB, aligning with the precision of robotic platforms. By reducing the risk of postoperative obstruction, it strengthens the bariatric surgery toolkit. This video presentation illustrates the technique’s execution, highlighting its practical application and potential to improve outcomes.