Robotic Revisional Bariatric Surgery Research Articles

Laparoscopic Versus Robotic Revisional Bariatric Surgery

Abstract Background Revisional bariatric surgery (RBS) represents up to 15% of all bariatric procedures. The most performed conversion procedures are Roux-en-Y-Gastric Bypass (RYGB) and Vertical Sleeve Gastrectomy (VSG) after adjustable gastric banding (AGB), VSG or vertical banded gastroplasty (VBG). While the overall complication rate is known to be higher compared to primary surgery, the optimal surgical approach, laparoscopic or robotic, remains controversial. Aims We aimed to compare laparoscopic and robotic RBS in terms of peri and post-operative complications, ICU admission, operative time, and the length of hospital stay. Methods We conducted a retrospective multi-center case control study of patients who underwent RBS from 2013 to 2023 in two centers. Cases and controls were matched by the index procedure, - AGB or a stapled procedure and the revisional procedure, - RYGB or VSG. Results 59 revisional procedures were performed (36 and 23 per center). After matching according to index and revisional procedures, 46 patients were included, 23 in the robotic and 23 in the laparoscopic group. There were no statistically significant differences in demographics, BMI, or comorbidities between the groups. The overall peri- and early post-operative complication rate was similar while patients in the laparoscopic group had a higher rate of severe complications and reoperations (13% versus 0%), however, without reaching a statistically significant difference (p = 0,07). The operative time was shorter in the laparoscopic group (161 +/- 55 versus 232 +/- 63 minutes, p < 0,05). Conclusion Our retrospective study showed a tendency towards more severe perioperative complications and reoperations in laparoscopic compared to robotic revisional surgery in patients with similar index and conversion procedures. Patients with complex revisional RYGB could benefit from robotic surgery. As the literature provides contrasting results, further studies should be performed to address this question.

Robotic Revisional Bariatric Surgery: a High-Volume Center Experience.

The number of bariatric revisional procedures is growing. Scarce evidence is available regarding the role and postoperative outcomes of robotic-assisted revisional bariatric surgery (RRBS). The aim of this study is to evaluate the safety and postoperative outcomes of RRBS. A retrospective analysis of a prospectively collected database of patients who underwent RRBS between 2012 and 2019 was performed. Primary outcomes of interest were 30-day major morbidity, mortality, length of hospital stay (LOS), urgent reoperation rates, and percentage of total weight loss (%TWL). RRBS was performed in 76 patients; among these 60 (78.9%) underwent conversion to Roux-en-Y gastric bypass (C-RYGB). Failed weight loss (76%) and gastroesophageal reflux (9.2%) were the main indications for revision. Primary bariatric procedures included gastric band (LAGB) (50%), sleeve gastrectomy (SG) (40.8%), and RYGB (6.6%). Major morbidity and mortality rates were 3.9% and 1.3%, respectively. Mean LOS was 2.1days, and 3 patients (3.9%) required urgent reoperation. The %TWL at 3, 6, 12, and 24months was 10.2%, 16.6%, 18.3%, and 22.4% respectively. Comparative analysis of C-RYGB after failed LAGB and SG showed similar morbidity. Higher readmission rates (SG: 22.2% vs. LAGB: 0%, p = 0.007) and lower %EWL at 3, 6, 12, and 24months were found in C-RYGB after SG. This is one of the largest single-center series of RRBS published in the literature; the data indicate that robotic approach for revisional bariatric surgery is safe and helps achieving further weight loss. RRBS outcomes might be influenced by the primary procedure.

Robotic-Assisted Surgery Results in a Shorter Hospital Stay Following Revisional Bariatric Surgery.

Revisional surgery is rapidly growing within the field of bariatric surgery. The use of robotic assisted surgery, considered controversial by many, may offer advantages in revisional bariatric surgery (RBS). There are few studies comparing laparoscopic and robotic-assisted RBS. The aim of this study is to compare the safety and outcome of laparoscopic and robotic RBS in a single accredited center. A retrospective analysis of data collected prospectively on patients undergoing either laparoscopic (L-RBS) or robotic (R-RBS) RBS between January 1, 2017 and December 31, 2019 was performed. The primary outcomes included length of stay (LOS), 30-day major and minor complication rates, readmission rates, and mortality rates. A total of 167 patients were included in our analysis. Fifty-two patients underwent R-RBS (31%), and 115 underwent L-RBS (69%). Thirty-day major and minor complication rates for R-RBS and L-RBS were 1.9% and 5.8% vs 5.2% and 5.2%, respectively (p > .05). There was no difference in readmission rates (3.8% vs 8.7%, p > 0.05) or intraoperative blood loss (35.5mL vs 37.4mL, p > .05) between R-RBS and L-RBS. R-RBS resulted in a shorter length of stay when compared with L-RBS (40.2h vs 62.6h, p < .05). R-RBS has a decreased, albeit non-significant, rate of 30-day major complications with no difference in minor complications, readmission rates, or intraoperative blood loss when compared with L-RBS. R-RBS resulted in a decreased length of stay when compared with L-RBS. Randomized clinical trials are needed to better elucidate our findings.

Outcomes of robotic surgery in revisional bariatric cases: a propensity score-matched analysis of the MBSAQIP registry.

In recent years, there has been a significant increase in the number of Revisional Bariatric Surgery (RBS) cases performed to address complications and weight recidivism. The use of the da Vinci robotic platform, considered controversial by many, may offer advantages in RBS. The objective of our study is to compare the outcomes of Robotic RBS (R-RBS) to Laparoscopic RBS (L-RBS). Using the 2015-2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, we selected all RBS and we matched R-RBS to L-RBS using a propensity score matching system to create balanced groups. Our primary outcomes were 30-day Serious Adverse Events (SAE), 30-day Organ Specific Infection (OSI), 30-day reoperation and 30-day interventions. Our secondary outcomes included length of operation and 30-day readmission. We conducted separate Mann-Whitney rank sums tests or chi-square tests and Fisher exact test. R-RBS and L-RBS included 220 patients each. The overall incidence of 30-day SAEs, 30-day OSIs, 30-day reoperations, 30-day interventions were lower for R-RBS (6.4%, 0.9%, 2.7% and 2.3%, respectively) compared L-RBS (7.7%, 1.4%, 3.6% and 3.6%, respectively). Subgroup analysis showed that R-RBS had a lower rate of complications for the Gastric Bypass procedure but not for Sleeve gastrectomy cases. However, 30-day readmission was higher for R-RBS compared to L-RBS (9.1% vs 6.4% respectively). None of the analyses reached statistical significance. R-RBS took significantly longer compared to L-RBS (169min vs 138min, p < 0.05). Our study shows that R-RBS has lower complication rate albeit non-significant as compared to L-RBS.

Pros and Cons of Robotic Revisional Bariatric Surgery

Introduction: Revisional procedures in bariatric surgery are regarded as technically more demanding and riskier than primary interventions. While the use of the surgical robot has not yet proven to be advantageous in primary bariatric interventions, the question remains whether its use is justified for more complex revisional procedures. Objective: To show that revisional bariatric surgery can be performed safely using the da Vinci® Xi surgical system. Methods: We performed a retrospective analysis of prospectively recorded data for revisional bariatric procedures between January 2016 and November 2019. Results: Of 78 revision operations, four (5.1%) were performed by open surgery, 30 (38.5%) by laparoscopic surgery, and 44 (56.4%) by robotic surgery. A comparative analysis of robotic (n = 41) versus laparoscopic (n = 18) revisional Roux-en-Y gastric bypasses (rRYGB) revealed significant differences favoring the robotic approach for operative time (130.7 vs. 167.6 min), C-reactive protein values at days 1 (27.9 vs. 49.1 mg/L) and 2 (48.2 vs. 83.6 mg/L) after surgery, and length of stay (4.9 vs. 6.2 days). Lower complication rates (Clavien-Dindo II–V) were found after rRRYGB (7.3 vs. 22.2%, not significant). Conclusions: Revisional bariatric surgery using a robotic system is safe. The operative time performing rRRYGB is significantly shorter than rLRYGB in our experience. Otherwise, results were largely comparable. Due to different indications, different index operations and a wide range of revisional procedures, further studies are necessary to confirm these results.

A601 Comparative study of laparoscopy and robotics in revisional bariatric surgery – outcomes in 138 patients

The rate of both revisional and robotic bariatric surgery is increasing. The advantages of robotic surgery in this setting are not clearly defined. Compare patient characteristics and outcomes of laparoscopic and robotic revisional bariatric surgery

A221 Comparative analysis of robotic versus laparoscopic revisional bariatric surgery outcomes from the MBSAQIP database

There is limited data evaluating the role of robotics in revisional bariatric surgery compared to laparoscopy. The purpose of this study was to compare outcomes of laparoscopic and robotic revisional bariatric surgery using the MBSAQIP database.

Perioperative Outcomes of Laparoscopic and Robotic Revisional Bariatric Surgery in a Complex Patient Population.

Utilization of the robotic platform has become more common in bariatric applications. We aim to show that robotic revisional bariatric surgery (RRBS) can be safely performed in a complex patient population with perioperative outcomes equivalent to laparoscopic revisional bariatric surgery (LRBS). Retrospective review was conducted of adult patients undergoing laparoscopic revisional bariatric surgery (LRBS) or robotic revisional bariatric surgery (RRBS) at our institution from September 2007 to December 2016. Patients undergoing planned two-stage bariatric procedures were excluded. A total of 84 patients who underwent LRBS (n = 66) or RRBS (n = 18) were included. The index operation was adjustable gastric banding (AGB) in 39/84 (46%), sleeve gastrectomy (VSG) in 23/84 (27%), Roux-en-Y gastric bypass (RYGB) in 13/84 (16%), and vertical banded gastroplasty (VBG) in 9/84 (11%). For patients undergoing conversion from AGB (n = 39), there was no difference in operative time, length of stay, or complications by surgical approach. For patients undergoing conversion from a stapled procedure (n = 45), the robotic approach was associated with a shorter length of stay (5.8 ± 3.3 vs 3.7 ± 1.7days, p = 0.04) with equivalent operative time and post-operative complications. There were three leaks in the LRBS group and none in the RRBS group (p = 0.36). Major complications occurred in 3/39 (8%) of patients undergoing conversion from AGB and 2/45 (4%) of patients undergoing conversion from a stapled procedure (p = 0.53) with no difference by surgical approach. RRBS is associated with a shorter length of stay than LRBS in complex procedures and has at least an equivalent safety profile. Long-term follow-up data is needed.

Experiencia inicial con cirugía revisional bariátrica asistida por robot

Introducción La cirugía bariátrica robótica es una técnica novedosa y en desarrollo en Chile. Los procedimientos bariátricos revisionales han aumentado durante los últimos años. No existen publicaciones en nuestro país relacionadas con experiencias en cirugía bariátrica revisional robótica. El objetivo de este estudio es describir la experiencia inicial y los resultados a corto plazo con el uso de la cirugía robótica en estos procedimientos.

A5198 - The Safety and Effectiveness of Totally Robotic Revisional Bariatric Surgery

Patients undergoing secondary bariatric procedures and revisions, in comparison to primary surgeries, are at higher risk for mortality and morbidity, including the risk for gastrointestinal leaks. The da Vinci robotic surgery system, with its ergonomic advantage, 3-D vision and tremor control may improve operative outcomes for high risk patients. To our knowledge, there are currently no studies of the safety and effectiveness of 'totally' robotic procedures for revisional bariatric surgery. In this study, we report on the surgical outcomes and rates of morbidity and mortality of a relatively large number of revisional bariatric procedures performed 'totally' robotic.

Robotic revisional bariatric surgery: single-surgeon case series.

Bariatric surgery is the only effective treatment for the long-term maintenance of significant weight loss. Minimally invasive revisional procedures are on the rise. Data is lacking in terms of safety, feasibility and outcomes with robotic revisional procedures. Robotic revisional bariatric procedures (RRBPs) of gastric band to Roux-en-Y gastric bypass and sleeve gastrectomy, revision of gastro-jejunal anastomosis and stricturoplasty performed during 2009-2013 were retrospectively reviewed. RRBPs were performed on 14 patients with mean age, pre-operative body mass index (BMI) and weight of 45.2 ± 11.4 years, 40.1 ± 8.7 kg/m2 and 109.4 ± 26 kg, respectively. The mean operative time, estimated blood loss and length of hospital stay were 220.6 ± 64.3) min, 31 ± 22.7 ml and 3.3 ± 1.5 days, respectively. There were no conversions, blood transfusions, gastrointestinal leaks, intraoperative complications or mortalities. RRBP can be performed safely without increased morbidity and with the added benefit of a minimally invasive approach. Copyright © 2014 John Wiley & Sons, Ltd.

Robotic revisional bariatric surgery: a comparative study with laparoscopic and open surgery

Revisional bariatric procedures (RBP) can be technically challenging. While robotics might provide help for complex procedures, the study aim was to report our experience with robotic RBP. From March 2000 to June 2013, 60 consecutive RBP (11 robotic, 21 laparoscopic, 28 open) have been prospectively entered into a dedicated database and reviewed retrospectively. Outcomes have been compared between the three approaches. The robotic group had fewer complications (0 vs. 14.3% for laparoscopy, vs. 10.7% for open; P > 0.05), but took longer than the other approaches (352 vs. 270 vs. 250 minutes respectively; P < 0.05). There were fewer conversions in the robotic group (0 vs. 14.3% for laparoscopy; P > 0.05), and a significantly shorter hospital stay (6 vs. 8 vs. 9 days, respectively). Robotic RBP is feasible and safe, but at the price of a longer operative time. The exact role of robotics remains yet to be defined for this indication in larger studies.