IBC-Oxford University2023_BJSOral_16Surgical Outcomes of Totally Robotic Versus Laparoscopic Primary Bariatric Metabolic Surgeries

Abstract

Abstract Background Over the past several years, the numbers of bariatric metabolic surgeries (BMS) performed robotic have been steadily increasing. Recent meta-analyses and registry reports find that primary surgeries performed robotic have similar outcomes to conventional laparoscopy but with longer operative times and higher costs. Most of the robotic surgeries in these reports, however, have been robot-assisted rather than totally (fully) robotic. The introduction of robotic staplers and conversion of the robotic system to the Xi platform now allow surgeons to perform bariatric surgeries totally robotic. Objectives To compare surgical outcomes of total robotic (TR) versus laparoscopic (LAP) primary bariatric metabolic surgeries (BMS) including sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and the biliopancreatic diversion with duodenal switch (DS). Methods The study is a retrospective analysis of 600 (302 TR and 298 LAP) primary BMS performed by a single surgeon between January 2020 and January 2023. Primary surgeries included 332 SG, 214 RYGB and 54 DS cases. Outcome measures included: 1) patient characteristics (age, weight, BMI, gender), 2) total number and incidence of preoperative co-morbidities, 3) operative time, 4) length of hospital stay (LOS), 5) complications, readmissions, and reoperations. Results Characteristics of the TR and LAP patients were similar, i.e., age = 45.5 vs. 44.9 y, respectively; BMI = 46.3 vs. 46.1; number major co-morbidities = 2.73 and 2.75. Operative times did not differ significantly between the TR and LAP approaches (84.3 vs. 88.2 min, respectively). LOS, however, was significantly (p<0.0001) less following surgeries performed totally robotic (1.16 days TR vs. 1.36 days LAP). There were no differences between the TR and LAP surgeries as regards 30-day readmission or reoperation rates but there was a trend toward fewer TR 30-day complications (2.3% TR vs. 5.0% LAP). With the RYGB, operative times were significantly lower for the totally robotic approach (99.6 min TR vs. 115.1 min LAP, p<0.0001) and LOS was significantly less (1.18 days TR vs. 1.38 days LAP, p<0.0001). For the SG, there were no significant differences between the TR and LAP approaches regarding operative times, but TR LOS was significantly (p<0.0001) less (1.13 days TR vs. 1.31 days LAP). Postoperative recovery rates (LOS) with the DS were also enhanced with the totally robotic approach (1.24 days TR vs. 1.58 days LAP, p=0.02), but operative times did not significantly differ (188.7 min TR, 176.5 min LAP). Conclusions Primary bariatric procedures (SG, RYGB, DS) performed totally robotic are as safe as conventional laparoscopy and have somewhat fewer complications, a faster rate of recovery, and,for the RYGB, shorter time in surgery.