Robotic Bariatric Surgery Research Articles

The Longitudinal Efficiency of Robotic Surgery: an MBSAQIP Propensity Matched 4-Year Comparison of Robotic and Laparoscopic Bariatric Surgery.

The objective of this study was to examine the MBSAQIP database to assess efficiency trends and perioperative outcomes in robotic bariatric surgery. Robotic (RA) and laparoscopic (L) sleeve gastrectomy (SG) and gastric bypass (RYGB) were compared using the 2015-2018 MBSAQIP Participant Use Data Files. Patients were propensity matched 1:1 based on sex, body mass index, assistant, and previous obesity or foregut surgery. A total of 93,802 patients were included. Median operative times were significantly longer for both RA-SG (89 vs. 62min; p < 0.0001) and RA-RYGB (141 vs. 105min; p < 0.0001) compared with laparoscopic. Over the 4-year period, the difference in operative times (OR delta) between RA-SG and L-SG was unchanged while the difference in operative times between RA-RYGB and L-RYGB increased. Both robotic groups were significantly more likely to be readmitted (RA-SG p = 0.001, RA-RYGB p = 0.006). Robotic SG was more likely to have a reintervention (p = 0.018) and extended length of stay (LOS) (> 4days) compared with laparoscopic (p = < 0.0002). No significant differences were noted in morbidity and mortality by approach. Operative times were 30% longer for RA-SG and 25% longer for RA-RYGB when compared with laparoscopic. There was no significant improvement in OR delta for either RA-SG or RA-RYGB over the four years. Readmission rates were higher for both RA-SG and RA-RYGB. Robotic SG had a greater percentage of patients with extended LOS compared with laparoscopic. No evidence of improved efficiency for robotic bariatric surgery as defined by operative time or clinical outcomes was identified.

The First Robotic Bariatric Surgery Performed in Thailand – Surgical Techniques and Review of the Literature

The First Robotic Bariatric Surgery Performed in Thailand – Surgical Techniques and Review of the Literature

Evolution of outcomes of robotic bariatric surgery: first report based on MBSAQIP database.

Robotic surgery is increasingly being used in bariatric surgery; however, the benefits of robotic surgery in bariatrics remain controversial. The objective of this study was to compare the outcomes of robotic bariatric surgery with laparoscopic surgery over a 3-year period between 2015 and 2017 using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. University Hospital, United States. Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for the years 2015 to 2017, we included patients who underwent primary robotic or laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass procedures. Patients were divided into either robotic or laparoscopic groups. Primary outcomes included serious adverse events, organ space infection (OSI), readmissions, reoperations, and interventions at 30 days. Secondary outcomes included operation length and hospital stay. We performed propensity score matching based on clinically relevant preoperative variables to create balanced groups before analysis. We analyzed our data using separate Cochran-Mantel-Haenszel tests with year as the stratification variable and conducted subgroup analyses for robotic patients only using separate t tests for proportions, with P < .05 denoting statistical significance. Of the 315,647 patients available for comparison in the 2015 to 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant User Files, there were 41,364 matched in the final data set. Using the Cochran-Mantel-Haenszel test, we found a significant association between year of performance and outcomes for OSI, 30 day-readmission, and intervention. The incidence of OSI after laparoscopic and robotic cases was .3% and .4%, respectively, in 2015 versus .2% and .3%, respectively, in 2017 (P = .04, odds ratio = 1.49). Thirty-day readmission for robotic cases was 5.2% in 2015 and 4.0% in 2017 (P < .05, odds ratio = 1.16). The incidence of 30-day intervention for robotic cases also dropped from 2.2% in 2015 to 1.3% in 2017 (P < .05, odds ratio = 1.37). Using a Student's t test, there was also a statistically significant decrease in serious adverse events in the robotic group between 2015 and 2017 (incidence of serious adverse events in 2015 was 5.2% versus 3.7% in 2017, P < .05). Rate of 30-day reoperation for the robotic group did change over time but was comparable to the laparoscopic group (1.4% versus 1.3%). Our study showed between 2015 and 2017 the outcomes of robotic bariatric surgery have improved as evidenced by the significant decrease in the rate of OSI, readmissions, and interventions at 30 days.

The Impact of Robotics in Learning Roux-en-Y Gastric Bypass: a Retrospective Analysis of 214 Laparoscopic and Robotic Procedures

BackgroundProximal Roux-en-Y gastric bypass is commonly used to manage obesity, performed using laparoscopic or robot-assisted minimally invasive surgery. As the prevalence of robotic bariatric surgery increases, further data is required to justify its use.MethodsThis was a large, retrospective analysis of prospectively recorded data for Roux-en-Y gastric bypass (RYGB) procedures performed using laparoscopic (LRYGB) or robotic (RRYGB; da Vinci Xi system, Intuitive Surgical Sàrl) surgery between January 2016 and March 2019. The surgical techniques did not differ apart from different trocar placements. Data collected included patient characteristics before and after RYGB, operative outcomes and complications.ResultsIn total, 114 RRYGB and 108 LRYGB primary surgeries were performed. There were no significant differences between the groups, apart from a significantly shorter duration of surgery (116.9 vs. 128.9 min, respectively), lower C-reactive protein values at days 1 (31.1 vs. 44.1 mg/l) and 2 (50.3 vs. 77.8 mg/l) after the intervention, and overall complication rate (4.4 vs. 12.0%, Clavien-Dindo classification II-V) with RRYGB compared with LRYGB. There was a lower hemoglobin value in the postoperative course after RRYGB (12.1 vs. 12.6 g/dl, day 2).ConclusionsIn our experience, robotic RYGB has proven to be safe and efficient, with a shorter duration of surgery and lower rate of complications than laparoscopic RYGB. RRYGB is easier to learn and seems safer in less experienced centers. Increasing experience with the robotic system can reduce the duration of surgery over time. Further studies with higher evidence level are necessary to confirm our results.

Outcomes of robotic bariatric surgery in super-obese patients: first report based on MBSAQIP database

Bariatric surgery in the super-obese (SO) patient population represents a challenge. Although the robotic platform is increasingly used for these patients, there are limited data on outcomes compared with conventional laparoscopy. Our study compared the safety and short-term outcomes of robotic and laparoscopic platforms for SO patients compared with morbidly obese patients based on the 2015 to 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. University Hospital, United States. We evaluated all primary robotic and laparoscopic cases and extracted 30-day outcomes in patients with body mass index <50 and ≤50 kg/m2. For our primary analysis, we used the Cochran-Mantel-Haenszel method with surgery type Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG) as the stratification variable to determine the association between body mass index categories and outcomes. A total of 355,278 patients were included in our analysis. For the robotic RYGB (R-RYGB) group (n = 6645) and R-SG (n = 15,984) there were 1674 SO patients (25.2%) and 3688 SO patients (23.1%), respectively.For the laparoscopic RYGB (LRYGB) group (n = 95,374) and LSG group (n = 237,275), there were 24,991 (26.2%) and 51,524 SO patients (21.7%), respectively. The incidence of serious adverse events in SO patients for R-RYGB and LRYGB groups was 7.6% versus 7.2% (P>.05) and 4% versus 3.5% (P > .05) for R-SG and L-SG, respectively. The incidence of organ space infection in SO patients for R-RYGB and LRYGB groups was .5% versus .4% (P > .05) and .4% versus .2% (P < .05) for R-SG and LSG, respectively. Based on 2015 to 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data, we found no difference in outcomes between robotic and laparoscopic approaches in SO patients. There was a higher incidence of serious adverse events in SO patients compared with morbidly obese patients for both approaches.

A544 Short-Term Outcomes of Robotic versus Laparoscopic Bariatric Surgery

Bariatric surgery aims to achieve weight loss and reduce weight-related co-morbidities with minimal complications. Laparoscopic bariatric surgery has long been the standard with an acceptably low complication rate. There is a growing body of evidence regarding robotic bariatric surgery and its outcomes. However, the precise role of robotics in bariatric surgery is not yet defined.

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

A280 Revisional Robotic Bariatric Surgery: Three Years of Data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

A280 Revisional Robotic Bariatric Surgery: Three Years of Data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

A586 Propensity Matched Comparison of Robotic and Laparoscopic Bariatric Surgery: Are we still in a learning curve or can we agree Robotic bariatric surgery is associated with longer operative times?

Robotic-assisted GI surgery has been uniformly associated with longer operative times. Previous studies report the bariatric learning curve as approximately 30 cases. The objective of this study was to compare operative times for the 3 available years of the MBSAQIP database to validate a learning curve toward shorter operative times.

Value of robotic-assisted technique in redo gastrojejunostomy for severe stenosis after gastric bypass.

Development of gastrojejunal stricture following Roux-en-Y gastric bypass (RYGB) leads to an increase in morbidity and adverse effects, such as abdominal pain, vomiting, aspiration pneumonia, and malnutrition. Up to 38.5% of patients will require revisional surgery for late anastomotic strictures despite conservative treatment. However, no previous studies focused on revisional robotic bariatric surgery due to strictures after RYGB have been reported. To evaluate our outcomes and assess the advantages of the robotic platform with regard to laparoscopic and open revisional procedures. University Hospital. We performed a retrospective analysis of patients who underwent laparoscopic robotic-assisted redo gastrojejunostomy from 2016 to 2018. Demographics, surgical data, medical treatments, postoperative outcomes, and adverse effects were collected. Nine patients with symptomatic anastomotic strictures after primary RYGB underwent robotic revisional surgery. All patients received medical therapy as a first approach, and five patients (55.5%) underwent endoscopic balloon dilation. All procedures were successfully completed with robotic assistance, with a mean (standard deviation) operative time of 184.5 (49.1)min, and no intraoperative adverse effects were registered. Median (range) hospital stay was 2 (1-4)days. One patient presented with a postoperative intra-abdominal abscess and was treated with intravenous antibiotics and image-guided drainage. No anastomotic leak, hemorrhage, or mortality were reported. Robotic assistance seems to be safe and effective for redo gastrojejunostomy secondary to stricture. Even though the sample size is small, we believe that the application of robotic techniques may provide advantages and improve the outcomes in these complex revisional procedures.

A Review of the Role of Robotics in Bariatric Surgery: Finding Our Future?

Introduction: Obesity rates continue to rise in America and around the World. Numerous studies show the benefit of bariatric surgery on all-cause mortality in obese patients. Given its substantial role in the future of patient care, we continue to search for the most beneficial ways to optimize patient outcomes and procedural costs in bariatric surgery. Much like laparoscopy was found to greatly improve the morbidity of weight loss surgery, we seek to evaluate the role of robotic surgery in bariatric procedures. Methods: We critically reviewed the available literature accessed through PubMed on the use of robotics in bariatric surgery. We aim to provide an overview of the conclusions from the most recent publications with commentary by the authors. Results: Although the outliers exist, it would appear that the majority of cases point to robotic surgery increasing operating room time and cost without providing significant generalizable improvements in patient outcomes. Promise exists in the use for special groups such as super obese patients or revisional bariatric procedures, however current studies in this subset are equally variable in their outcomes. Conclusion: Despite the current assumptions, we believe there is a future in bariatric surgery for robotics. This may inevitably be seen in the more demanding and difficult cases or in the advancement of the available technology. Likely, as robotics continues to mature, applied artificial intelligence will provide enhanced cues during surgery that augment the surgeon's judgment and skill and result in unanimously improved patient outcomes.

Use of barbed sutures in robotic bariatric bypass surgery: a single-center case series

BackgroundSurgical robots are increasingly being used in bariatric surgery. While several studies describe the safety of using barbed sutures in laparoscopic gastric bypass surgery, no reports are available for robotic bariatric procedures. The aim of our article is to determine whether barbed sutures can be used safely in robotic Roux-en-Y bypass (RYGB) surgery.MethodsThis was a single-center, single-surgeon case series of RYGB procedures using the da Vinci® Xi Surgical System (Intuitive Surgery, Sunnyvale, CA, USA) in combination with the use of barbed sutures (Stratafix, Ethicon, Johnson & Johnson, Cincinnati, OH, USA).ResultsFifty robotic proximal and distal RYGB surgeries were performed. A linear stapled, side-to-side gastrojejunostomy was carried out, whereby the enterotomy was completed with a running resorbable unidirectional barbed suture, Stratafix 2–0. In one case after robotic proximal RYGB, revision surgery was required due to omentum necrosis. Another patient was readmitted due to gastrointestinal bleeding from anastomosis. No anastomotic insufficiencies, no stenoses, or higher-grade complications according to Clavien-Dindo 4a-5 were found.ConclusionsWe found that the use of self-fixing barbed sutures in robotic RYGB is safe. The self-fixing suture enables the robotic surgeon to perform a simple continuous suture without the need for recurrent retraction. Although we are the first to report this procedure, we had a low number of cases and no control group; thus, further studies with a higher level of evidence are required.

PSU6 IMPACT OF PROCEDURE VOLUME ON 30-DAY ALL-CAUSE READMISSIONS IN LAPAROSCOPIC AND ROBOTIC BARIATRIC SURGERY

To examine the impact of procedure volume on 30-day all-cause readmissions among patients undergoing laparoscopic or robotic bariatric surgery. We extracted hospital discharge records from the Premier Healthcare Database for patients aged≥18 undergoing elective laparoscopic or robotic bariatric surgery (Roux-en-Y gastric bypass, sleeve gastrectomy) between 1-1-2015 and 12-31-2017 (first admission=index). For each patient, we used the month of index and 12 months prior to measure their hospital’s annual procedure volume of the specific procedure/approach that they underwent (Roux-en-Y/laparoscopic, Roux-en-Y/robotic, sleeve/laparoscopic, sleeve/robotic); we then used multivariable generalized estimating equations to quantify the association between the annual procedure volume (categorized in quartiles [Q1-Q4] from low-to-high volume) and 30-day all-cause readmission to the same hospital in which the bariatric surgery was performed, accounting for hospital-level clustering and adjusting for patients’ demographics, body mass index, comorbidities, and provider/hospital characteristics. The study included 30,301 Roux-en-Y/laparoscopic, 2,751 Roux-en-Y/robotic, 66,788 sleeve/laparoscopic, and 6,227 sleeve/robotic patients from 294 hospitals. In analyses of the laparoscopic approach, higher annual procedure volume was significantly associated with lower adjusted risk of 30-day all-cause readmission (Roux-en-Y/laparoscopic: Q1=6.5%, Q2=5.9%, Q3=4.8%, Q4=4.6%, P=0.002; sleeve/laparoscopic: Q1=3.3%, Q2=2.8%, Q3=2.9%, Q4=2.3%, P=0.006). In contrast, for the robotic approach, procedure volume was not significantly associated with adjusted risk of 30-day all-cause readmissions (Roux-en-Y/robotic: Q1=7.1 %, Q2=7.2%, Q3=7.0%, Q4=5.6%, P=0.836; sleeve/robotic: Q1=2.8%, Q2=2.5%, Q3=2.9%, Q4=3.9%, P=0.335). Among patients undergoing elective bariatric surgery, higher hospital procedure volume was significantly associated with lower adjusted risks of 30-day all-cause readmission for laparoscopic procedures but not robotic procedures. The robotic approach is a relatively new and less common technique in bariatric surgery; readmission data may reflect the fact that robotics is in early experience with hospitals and surgeons still advancing on their learning curves. More research is needed to understand the hospital and surgeon-specific factors which influence outcomes in robotic bariatric surgery.

A361 - Resident involvement in robotic bariatric surgery: A MBSAQIP analysis

Background: As robotic bariatric surgery becomes more common, it is important to assess complications as trainees become more involved in these procedures. The Metabolic and Bariatric Surgical Association Quality Improvement Program (MBSAQIP) records bariatric surgery-specific complications for all procedures at member institutions. Our hypothesis was that resident involvement in robotic bariatric surgery does not increase complications.

A165 - Perioperative outcomes following robotic bariatric surgery: an MBSAQIP analysis

A165 - Perioperative outcomes following robotic bariatric surgery: an MBSAQIP analysis

A481 - Comparison of Laparoscopic to Robotic Bariatric Surgery in Community Hospital Program

Objectives: Laparoscopic sleeve gastrectomy, laparoscopic roux-en-y gastric bypass and revisional bariatric surgery are the most popular bariatric surgical procedures performed today for treatment of morbid obesity, accounting for 90.7% of all bariatric surgeries in 2016. Many bariatric patients pose unique issues for the surgeon due to body habitus. Robotic surgery is gaining popularity among bariatric surgeons as a way to perform many of these surgeries. The enhanced visualization and ergonomic dexterity may offer these surgeons advantages in the morbidly obese.

Utilization and Outcomes among Adopters and Abandoners of Robotics in Bariatric Surgery

Utilization and Outcomes among Adopters and Abandoners of Robotics in Bariatric Surgery

Contemporary Role of Robotics in Bariatric Surgery: Experience of CUF Infante Santo Hospital

INTRODUCTION: The use of robotics in bariatric surgery is increasing worldwide, with the main objective of reducing complications and optimising surgical outcome. This study presents a single centre 1.5-year experience and clinical outcome with robotic gastric bypass.&#x0D; METHODS: A retrospective review was performed of 42 consecutive patients who underwent a robotic gastric bypass. Patient files were analysed to obtain patient characteristics, weight loss results and per-and postoperative morbidity.&#x0D; RESULTS: In 32/42 patients, a primary gastric bypass was performed, the remaining 10 procedures were revision cases. Mean start weight was 111.1 (+/- 20.5) kg, mean start BMI was 39.7 (+/- 5.6) kg/m2. Almost half of the patients presented with pre-existing comorbidities. After a mean follow-up of 9.1 (+/-5.2) months, mean body mass index was 30.16 (+/-5.3) kg/m2 with a percentage excess weight loss of 66.16 (+/- 43.6)%. There were no conversions, no leaks and no mortality. Two patients presented with minor complications; one infected hematoma and one anastomotic ulcer. Mean length of stay in the hospital was 2.8 (2-5) days. All but one patients were satisfied with the weight loss result.&#x0D; CONCLUSION: The robotic gastric bypass is a safe and reproducible approach to treat morbid obesity. A secure handsewn gastrojejunal anastomosis, quick recovery and better ergonomics are the main advantages of this technique.

Perioperative outcomes and anesthetic considerations of robotic bariatric surgery in a propensity-matched cohort of super obese and super-super obese patients.

The use of the robotic platform has not been well established in patients with super obesity (SO; body mass index, BMI ≥ 50) and super-super obesity (SSO, BMI ≥ 60). We aimed to determine safety and feasibility of robotic bariatric surgery in this cohort. Review of a prospectively maintained database was performed of consecutive patients undergoing robotic bariatric surgery between 2015 and 2017. Propensity score analysis with 1:2 nearest neighbor matching was performed to control for baseline characteristics and procedure type. A propensity-matched cohort of 47 SO patients (median BMI 55.3, range 50.1-92.5) and 94 morbidly obese (MO; median BMI 41.8, range 35.1-48.8) patients were analyzed. After matching, there were no difference in baseline characteristics including age, American Society of Anesthesiologists (ASA) score, or preoperative comorbidities. Most patients in each group underwent sleeve gastrectomy (81% of SO patients versus 76% of MO patients) or Roux-en-Y gastric bypass (13% vs. 18%, respectively), p = 0.66. There were no differences in operative time, intraoperative complications, postoperative complications, or re-admissions between groups. Length of stay was slightly longer in the MO group (2.2days, IQR 1.8-3.2 vs. 1.8days, IQR 1.2-2.7; p = 0.01). A subset of SSO patients (n = 11, median BMI 67, range 60-92) was analyzed; there was no increase in operation time, and zero intraoperative complications, conversions to open, or postoperative complications in this subset. Robotic bariatric surgery can safely be performed on patients with SO or SSO with low perioperative morbidity and no increase in operating time.

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.