Abstract
Background
Robotic technology leads to improved visualization and precision over laparoscopy but also higher cost of care. The benefits of this technology to patient outcomes are controversial. Our objective was to assess whether the application of robotic surgery to Roux-en-Y gastric bypass (RYGB) would lead to improved patient outcomes.
Methods
A prospectively collected database at a bariatric center of excellence was reviewed for all RYGB procedures performed by one surgeon between 2007 and 2015. Procedures performed laparoscopically (transoral circular stapling technique) versus robotically (hand-sewn anastomosis) were compared; the transition in technique occurred in 2011. Patient demographics, baseline weight, BMI, operation duration, estimated blood loss (EBL), length of hospital stay (LOS), morbidity and mortality, and percent excess weight loss (%EWL) at 1-year follow-up were compared between groups. Morbidity up to 1-year postop was assessed using the Clavien–Dindo classification.
Results
Of 246 patients, 125 underwent robotic and 121 laparoscopic RYGB. Patients in the robotic group were older and heavier but achieved similar %EWL to the laparoscopic group. The operative duration was longer but the mean patient LOS was shorter with the robotic approach. There were no leaks and no mortality. Based on the Clavien–Dindo classification, fewer overall and fewer severe complications occurred in the robotic compared with the laparoscopic approach.
Conclusion
In our experience, the use of robotic technology for the creation of gastric bypass led to longer operative times, similar %EWL but decreased LOS and number and severity of complications compared with the laparoscopic approach. Since our findings may have been influenced by the type of anastomotic technique used with each approach they need confirmation by a controlled trial.
Similar content being viewed by others
References
Menifield CE, Doty N, Fletcher A (2008) Obesity in America. ABNF J 19:83–88
Bailey JG, Hayden JA, Davis PJ, Liu RY, Haardt D, Ellsmere J (2013) Robotic versus laparoscopic Roux-en-Y gastric bypass (RYGB) in obese adults ages 18-65 years: a systematic review and economic analysis. Surg Endosc 28:414–426
Pi-Sunyer FX (1999) Comorbidities of overweight and obesity: current evidence and research issues. Med Sci Sports Exerc 31(11):S602–S608
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric Surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737
Pories WJ, Caro JF, Flickinger EG, Meelheim HD, Swanson MS (1987) The control of diabetes mellitus (NIDDM) in the morbidly obese with the greenville gastric bypass. Ann Surg 206:316–323
Noria SF, Grantcharov T (2013) Biological effects of bariatric surgery on obesity-related comorbidities. Can J Surg 56:47–57
McGuire MT, Wing RR, Klem ML, Seagle HM, Hill JO (1998) Long-term maintenance of weight loss: do people who lose weight through various weight loss methods use different behaviors to maintain their weight? Int J Obes Relat Metab Disord 22:572–577
Smeenk RM, van ‘tHof G, Elsten E, Feskens PG (2016) The results of 100 robotic versus 100 laparoscopic gastric bypass procedures: a single high volume centre experience. Obes Surg 26:1266–1273. doi:10.1007/s11695-015-1933-y
Agaba EA, Rainville H, Ikedilo O, Vemulapali P (2014) Incidence of port-site incisional hernia after single-incision laparoscopic surgery. JSLS 18:204–210
Reoch J, Mottillo S, Shimon A (2011) Safety of laparoscopic vs. open bariatric surgery: a systematic review and meta-analysis. Arch Surg 146:1314–1322
Gonzalez R, Lin E, Venkatesh KR (2003) Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg 138:181–184
Doumouras AG, Saleh F, Anvari S, Gmora S, Anvari M, Hong D (2017) Mastery in bariatric surgery: the long-term surgeon learning curve of Roux-en-Y gastric bypass. Ann Surg. doi:10.1097/SLA.0000000000002180
Palep JH (2009) Robotic assisted minimally invasive surgery. J Minim Access Surg 5:1–7
Jacobsen G, Berger R, Horgan S (2003) The role of robotic surgery in morbid obesity. J Laparoendosc Adv Surg TechA 13:279–283
Buchs NC, Azagury DE, Pugin F, Jung MK, Huber O, Chassot G, Morel P (2016) Roux-en-Y gastric bypass for super obese patients: what approach? Int J Med Robot 12(2):276–282
Fourman MM, Saber AA (2012) Robotic bariatric surgery: a systematic review. Surg Obes Relat Dis. 8(4):483–488
Economopoulos KP, Theocharidis V, McKenzie TJ, Sergentanis TN, Psaltopoulou T (2015) Robotic vs. laparoscopic Roux-en-Y gastric bypass: a systematic review and meta-analysis. Obes Surg 25:2180–2189
Higgins RM, Frelich MJ, Bosler ME, Gould JC (2017) Cost analysis of robotic versus laparoscopic general surgery procedures. Surg Endosc 31(1):185–192
Strosberg DS, Nguyen MC, Muscarella P 2nd, Narula VK (2017) A retrospective comparison of robotic cholecystectomy versus laparoscopic cholecystectomy: operative outcomes and cost analysis. Surg Endosc 31(3):1436–1441
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196
Ahmad A, Carleton JD, Ahmad ZF, Agarwala A (2016) Laparoscopic versus robotic-assisted Roux-en-Y gastric bypass: a retrospective, single center study of early perioperative outcomes at a community hospital. Surg Endosc 30:3792–3796
Lanfranco AR, Castellanos AE, Desai JP, Meyers WC (2004) Robotic Surgery: a Current Perspective. Ann Surg 239:14–21
Buchs NC, Morel P, Azagury DE, Jung M, Chassot G, Huber O, Hagen ME, Pugin F (2014) Laparoscopic versus robotic Roux-en-Y gastric bypass: lessons and long-term follow-up learned from a large prospective monocentric study. Obes Surg 24:2031–2039
Moon RC, Gutierrez JC, Royall NA, Teixeira AF, Jawad MA (2016) Robotic Roux-en-Y gastric bypass, is it safer than laparoscopic bypass? Obes Surg 26:1016–1020
Lyn-Sue JR, Winder JS, Kotch S, Colello J, Docimo S (2016) Laparoscopic gastric bypass to robotic gastric bypass: time and cost commitment involved in training and transitioning an academic surgical practice. J Robot Surg 10:111–115
Lois AW, Frelich MJ, Goldblatt MI, Wallace JR, Gould JC (2015) Gastrojejunostomy technique and anastomotic complications in laparoscopic gastric bypass. Surg Obes Relat Dis. 11:808–813
Rashidi L, Neighorn C, Bastawrous A (2017) Outcome comparisons between high-volume robotic and laparoscopic surgeons in a large healthcare system. Am J Surg 213(5):901–905
DaVinci training (2017) Intuitive Surgical website. Available at: https://www.intuitivesurgical.com/training/ Accessed 26 March 2017
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Drs. Dimitrios Stefanidis and Timothy Kuwada, and Savannah B. Bailey and Connie Simms have no conflicts of interest or financial ties to disclose. Dr Keith Gersin is paid consultant for GI Dynamics, WL Gore, and on the speaker’s bureau for Mallinckrodt.
Rights and permissions
About this article
Cite this article
Stefanidis, D., Bailey, S.B., Kuwada, T. et al. Robotic gastric bypass may lead to fewer complications compared with laparoscopy. Surg Endosc 32, 610–616 (2018). https://doi.org/10.1007/s00464-017-5710-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-017-5710-y