PERSPECTIVE article
Front. Surg.
Sec. Visceral Surgery
This article is part of the Research Topic10th Anniversary of Frontiers in Surgery: Celebrating Progress and Envisioning the Future of Multidisciplinary SurgeryView all 20 articles
Robotic Hormonal and Autonomic Modulation for Type 2 Diabetes: Ileal Interposition and Hepatic Sympathectomy Perspective Article
Provisionally accepted
- 1Clinica Alcides José Branco Filho Med Associates, Curitiba, Brazil
- 2Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- 3Harvard T H Chan School of Public Health, Boston, United States
- 4Pontificia Universidade Catolica do Parana, Curitiba, Brazil
- 5Kent State University, Kent, United States
- 6Hospital Cruz Vermelha, Curitiba, Brazil
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Background: Type 2 diabetes mellitus (T2DM) is a complex disorder involving both hormonal imbalance and autonomic dysfunction. While bariatric surgery enhances glycemic control, its effects on autonomic regulation are limited. Objective: This is the first report describing two novel robotic surgical strategies targeting dual physiological mechanisms—hormonal modulation and sympathetic overactivity—to optimize metabolic outcomes in T2DM. The manuscript is intended to spark discussion around future surgical strategies based on two proof-of-concept index cases. Methods: We present two patients with poorly controlled T2DM and metabolic syndrome. Case 1 underwent robotic ileal interposition with sleeve gastrectomy and duodenal exclusion, aiming to enhance incretin response and reduce glucagon levels. Case 2 underwent sleeve gastrectomy and duodenoileal interposition combined with selective hepatic sympathectomy, targeting sympathetic overactivity and autonomic dysfunction. Both procedures were performed using a robotic platform to enhance surgical precision. Results: Both procedures were completed successfully with minimal complications. The first patient showed significant weight loss and reduced insulin requirements after 12 months. The second patient reported resolution of sleep apnea symptoms and decreased paresthesia in the lower limbs, suggesting autonomic improvement. Conclusion: These cases highlight the safety, feasibility, and physiological rationale of combining robotic metabolic procedures with targeted autonomic modulation. This integrated approach may offer a promising pathway for treating complex metabolic disorders by addressing both hormonal and neural dysfunction. Further studies are warranted to validate these findings.
Keywords: type 2 diabetes, robotic surgery, Ileal interposition, Sympathectomy, metabolic surgery, perspective article
Received: 01 Jul 2025; Accepted: 03 Nov 2025.
Copyright: © 2025 FIlho, Brioschi, Brioschi and Barbosa. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Marcos Brioschi, termometria@yahoo.com.br
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