Advertisement

Surgical Endoscopy

, Volume 33, Issue 5, pp 1600–1612 | Cite as

Robot-assisted versus laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a propensity score-matched comparative analysis using the 2015–2016 MBSAQIP database

  • Raul SebastianEmail author
  • Melanie H. Howell
  • Kai-Hua Chang
  • Gina Adrales
  • Thomas Magnuson
  • Michael Schweitzer
  • Hien Nguyen
2018 SAGES Oral

Abstract

Background

Robotic-assisted bariatric surgery is part of the armamentarium in many bariatric centers. However, limited data correlate the robotic benefits to with clinical outcomes. This study compares 30-day outcomes between robotic-assisted and laparoscopic procedures for Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

Methods

Using the 2015–2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, patients between18- and 65-year-old were included. To adjust for potential confounders, 1:1 propensity-score matching (PSM) was performed using 22 preoperative characteristics. Second PSM analysis was performed adding operative time and conversion rate.

Results

269,923 patients underwent SG (n = 190,494) or RYGB (n = 79,429). The operative time was significantly longer in the Robotic-assisted compared to laparoscopic approach either for SG (102.58 ± 46 vs. 73.38 ± 36; P < 0.001) or for RYGB (158.29 ± 65 vs. 120.17 ± 56; P < 0.001). In the SG cohort (12,877 matched cases), the robotic approach showed significant reduction of postoperative bleeding (0.16% vs. 0.43%; P < 0.001) and strictures (0.19% vs. 0.33%; P = 0.04) with similar results in the other 30-day outcomes in both analyses. Similarly, for the RYGB cohort (5780 matched cases), the robotic approach showed significantly fewer requirements for blood transfusions (0.64% vs. 1.16%; P = 0.004) with no statistically different results for the other’s outcomes. Conversely, when adding operative time and conversion rate to the PSM analysis, the robotic platform showed significantly shorter length of stay (2.12 ± 1.9 vs. 2.30 ± 3.1 days; P < 0.001), reduction of anastomotic leak (0.52% vs. 0.92%; P = 0.01), renal complications (0.16% vs. 0.38%; P = 0.004), and venous thromboembolism (0.24% vs. 0.52%; P = 0.02).

Conclusions

Our findings show that postoperative bleeding and blood transfusion are significantly reduced with the robotic platform, and after correcting for all factors including operative time, the robotic-assisted approach is associated with better postoperative outcomes especially for RYGB.

Keywords

Bariatric surgery Robotic bariatric surgery Robotic sleeve gastrectomy Robotic gastric bypass Minimally invasive surgery 

Notes

Compliance with ethical standards

Disclosures

Raul Sebastian, Melanie H. Howell, Kai-Hua Chang, Gina Adrales, Thomas Magnuson, Michael Schweitzer and Hien Nguyen have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. ([online] 2015) BRFSS prevalence & trends dataGoogle Scholar
  2. 2.
    Hales CM, Carroll MD, Fryar CD, Ogden CL (2017) Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief:1–8Google Scholar
  3. 3.
    ASMBS Estimate of bariatric surgery numbers, 2011–2016. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers
  4. 4.
    Wittgrove AC, Clark GW, Tremblay LJ (1994) Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg 4:353–357.  https://doi.org/10.1381/096089294765558331 CrossRefGoogle Scholar
  5. 5.
    Antoniou SA, Antoniou GA, Koch OO, Köhler G, Pointner R, Granderath F- (2015) Laparoscopic versus open obesity surgery: a meta-analysis of pulmonary complications. Dig Surg 32:98–107.  https://doi.org/10.1159/000371749 CrossRefGoogle Scholar
  6. 6.
    Masoomi H, Nguyen NT, Stamos MJ, Smith BR (2012) Overview of outcomes of laparoscopic and open Roux-en-Y gastric bypass in the United States. Surg Technol Int 22:72–76Google Scholar
  7. 7.
    Moose D, Lourie D, Powell W, Pehrsson B, Martin D, Lamar T, Alexander J (2003) Laparoscopic Roux-en-Y gastric bypass: minimally invasive bariatric surgery for the superobese in the community hospital setting. Am Surg 69:930–932Google Scholar
  8. 8.
    Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, Lee SJ, Wolfe BM (2001) Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 234:279–291.  https://doi.org/10.1097/00000658-200109000-00002 CrossRefGoogle Scholar
  9. 9.
    Reoch J, Mottillo S, Shimony A, Filion KB, Christou NV, Joseph L, Poirier P, Eisenberg MJ (2011) Safety of laparoscopic vs open bariatric surgery: a systematic review and meta-analysis. Arch Surg 146:1314–1322.  https://doi.org/10.1001/archsurg.2011.270 CrossRefGoogle Scholar
  10. 10.
    Lee GI, Lee MR, Clanton T, Sutton E, Park AE, Marohn MR (2014) Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries. Surg Endosc 28:456–465.  https://doi.org/10.1007/s00464-013-3213-z CrossRefGoogle Scholar
  11. 11.
    Kenngott HG, Müller-Stich BP, Reiter MA, Rassweiler J, Gutt CN (2008) Robotic suturing: technique and benefit in advanced laparoscopic surgery. Minim Invasive Ther Allied Technol 17:160–167.  https://doi.org/10.1080/13645700802103381 CrossRefGoogle Scholar
  12. 12.
    Prasad SM, Prasad SM, Maniar HS, Chu C, Schuessler RB, Damiano RJ Jr (2004) Surgical robotics: impact of motion scaling on task performance. J Am Coll Surg 199:863–868.  https://doi.org/10.1016/j.jamcollsurg.2004.08.027 CrossRefGoogle Scholar
  13. 13.
    Choussein S, Srouji SS, Farland LV, Wietsma A, Missmer SA, Hollis M, Yu RN, Pozner CN, Gargiulo AR (2018) Robotic assistance confers ambidexterity to laparoscopic surgeons. J Minim Invasive Gynecol 25:76–83.  https://doi.org/10.1016/j.jmig.2017.07.010 CrossRefGoogle Scholar
  14. 14.
    Bindal V, Gonzalez-Heredia R, Masrur M, Elli EF (2015) Technique evolution, learning curve, and outcomes of 200 robot-assisted gastric bypass procedures: a 5-year experience. Obes Surg 25:997–1002.  https://doi.org/10.1007/s11695-014-1502-9 CrossRefGoogle Scholar
  15. 15.
    Ayloo S, Fernandes E, Choudhury N (2014) Learning curve and robot set-up/operative times in singly docked totally robotic Roux-en-Y Gastric bypass. Surg Endosc 28:1629–1633.  https://doi.org/10.1007/s00464-013-3362-0 CrossRefGoogle Scholar
  16. 16.
    Buchs NC, Pugin F, Bucher P, Hagen ME, Chassot G, Koutny-Fong P, Morel P (2012) Learning curve for robot-assisted Roux-en-Y gastric bypass. Surg Endosc 26:1116–1121.  https://doi.org/10.1007/s00464-011-2008-3 CrossRefGoogle Scholar
  17. 17.
    Bailey JG, Hayden JA, Davis PJB, Liu RY, Haardt D, Ellsmere J (2014) Robotic versus laparoscopic Roux-en-Y gastric bypass (RYGB) in obese adults ages 18 to 65 years: a systematic review and economic analysis. Surg Endosc 28:414–426.  https://doi.org/10.1007/s00464-013-3217-8 CrossRefGoogle Scholar
  18. 18.
    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 Rob Surg 10:111–115.  https://doi.org/10.1007/s11701-016-0567-y CrossRefGoogle Scholar
  19. 19.
    Villamere J, Gebhart A, Vu S, Nguyen NT (2015) Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at Academic Medical Centers. Surg Endosc 29:1729–1736.  https://doi.org/10.1007/s00464-014-3886-y CrossRefGoogle Scholar
  20. 20.
    Stefanidis D, Bailey SB, Kuwada T, Simms C, Gersin K (2017) Robotic gastric bypass may lead to fewer complications compared with laparoscopy. Surg Endosc.  https://doi.org/10.1007/s00464-017-5710-y Google Scholar
  21. 21.
    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.  https://doi.org/10.1007/s11695-015-1870-9 CrossRefGoogle Scholar
  22. 22.
    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.  https://doi.org/10.1007/s11695-014-1335-6 CrossRefGoogle Scholar
  23. 23.
    Tieu K, Allison N, Snyder B, Wilson T, Toder M, Wilson E (2013) Robotic-assisted Roux-en-Y gastric bypass: update from 2 high-volume centers. Surg Obes Relat Dis 9:284–289.  https://doi.org/10.1016/j.soard.2011.11.022 CrossRefGoogle Scholar
  24. 24.
    Hagen ME, Pugin F, Chassot G, Huber O, Buchs N, Iranmanesh P, Morel P (2012) Reducing cost of surgery by avoiding complications: the model of robotic Roux-en-Y gastric bypass. Obes Surg 22:52–61.  https://doi.org/10.1007/s11695-011-0422-1 CrossRefGoogle Scholar
  25. 25.
    Snyder BE, Wilson T, Scarborough T, Yu S, Wilson EB (2008) Lowering gastrointestinal leak rates: a comparative analysis of robotic and laparoscopic gastric bypass. J Rob Surg 2:159–163.  https://doi.org/10.1007/s11701-008-0104-8 CrossRefGoogle Scholar
  26. 26.
    Thoemmes FJ, Kim ES (2011) A systematic review of propensity score methods in the Social sciences. Multiv Behav Res 46:90–118.  https://doi.org/10.1080/00273171.2011.540475 CrossRefGoogle Scholar
  27. 27.
    Cadiere GB, Himpens J, Vertruyen M, Favretti F (1999) The world’s first obesity surgery performed by a surgeon at a distance. Obes Surg 9:206–209.  https://doi.org/10.1381/096089299765553539 CrossRefGoogle Scholar
  28. 28.
    Horgan S, Vanuno D (2001) Robots in laparoscopic surgery. J Laparoendosc Adv Surg Tech A 11:415–419.  https://doi.org/10.1089/10926420152761950 CrossRefGoogle Scholar
  29. 29.
    Sudan R, Puri V, Sudan D (2007) Robotically assisted biliary pancreatic diversion with a duodenal switch: a new technique. Surg Endosc 21:729–733.  https://doi.org/10.1007/s00464-006-9171-y CrossRefGoogle Scholar
  30. 30.
    Li K, Zou J, Tang J, Di J, Han X, Zhang P (2016) Robotic versus laparoscopic bariatric surgery: a systematic review and meta-analysis. Obes Surg 26:3031–3044.  https://doi.org/10.1007/s11695-016-2408-5 CrossRefGoogle Scholar
  31. 31.
    Jackson TD, Wannares JJ, Lancaster RT, Rattner DW, Hutter MM (2011) Does speed matter? the impact of operative time on outcome in laparoscopic surgery. Surg Endosc 25:2288–2295.  https://doi.org/10.1007/s00464-010-1550-8 CrossRefGoogle Scholar
  32. 32.
    Procter LD, Davenport DL, Bernard AC, Zwischenberger JB (2010) General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg 210(e2):60–65.  https://doi.org/10.1016/j.jamcollsurg.2009.09.034 CrossRefGoogle Scholar
  33. 33.
    Daley BJ, Cecil W, Clarke PC, Cofer JB, Guillamondegui OD (2015) How slow is too slow? Correlation of operative time to complications: an analysis from the tennessee surgical quality collaborative. J Am Coll Surg 220:550–558.  https://doi.org/10.1016/j.jamcollsurg.2014.12.040 CrossRefGoogle Scholar
  34. 34.
    Reames BN, Bacal D, Krell RW, Birkmeyer JD, Birkmeyer NJO, Finks JF (2015) Influence of median surgeon operative duration on adverse outcomes in bariatric surgery. Surg Obes Relat Dis 11:207–213.  https://doi.org/10.1016/j.soard.2014.03.018 CrossRefGoogle Scholar
  35. 35.
    Zettervall SL, Amdur R, Vaziri K (2015) Outcomes of prolonged laparoscopic bariatric operations compared with shorter open procedures. Surg Laparosc Endosc Percutaneous Tech 25:496–499.  https://doi.org/10.1097/SLE.0000000000000205 CrossRefGoogle Scholar
  36. 36.
    Magouliotis DE, Tasiopoulou VS, Sioka E, Zacharoulis D (2017) Robotic versus laparoscopic sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis. Obes Surg 27:245–253.  https://doi.org/10.1007/s11695-016-2444-1 CrossRefGoogle Scholar
  37. 37.
    Celio AC, Kasten KR, Schwoerer A, Pories WJ, Spaniolas K (2017) Perioperative safety of laparoscopic versus robotic gastric bypass: a propensity matched analysis of early experience. Surg Obes Relat Dis 13:1847–1852.  https://doi.org/10.1016/j.soard.2017.07.016 CrossRefGoogle Scholar
  38. 38.
    Romero RJ, Kosanovic R, Rabaza JR, Seetharamaiah R, Donkor C, Gallas M, Gonzalez AM (2013) Robotic sleeve gastrectomy: experience of 134 cases and comparison with a systematic review of the laparoscopic approach. Obes Surg 23:1743–1752.  https://doi.org/10.1007/s11695-013-1004-1 CrossRefGoogle Scholar
  39. 39.
    Ayloo S, Buchs NC, Addeo P, Bianco FM, Giulianotti PC (2011) Robot-assisted sleeve gastrectomy for super-morbidly obese patients. J Laparoendosc Adv Surg Tech 21:295–299.  https://doi.org/10.1089/lap.2010.0398 CrossRefGoogle Scholar
  40. 40.
    Biffi R, Luca F, Pozzi S, Cenciarelli S, Valvo M, Sonzogni A, Radice D, Ghezzi TL (2011) Operative blood loss and use of blood products after full robotic and conventional low anterior resection with total mesorectal excision for treatment of rectal cancer. J Rob Surg 5:101–107.  https://doi.org/10.1007/s11701-010-0227-6 CrossRefGoogle Scholar
  41. 41.
    Sharma G, Strong AT, Tu C, Brethauer SA, Schauer PR, Aminian A (2018) Robotic platform for gastric bypass is associated with more resource utilization: an analysis of MBSAQIP dataset. Surg Obes Relat Dis 14:304–310.  https://doi.org/10.1016/j.soard.2017.11.018 CrossRefGoogle Scholar
  42. 42.
    Myers SR, McGuirl J, Wang J (2013) Robot-assisted versus laparoscopic gastric bypass: comparison of short-term outcomes. Obes Surg 23:467–473.  https://doi.org/10.1007/s11695-012-0848-0 CrossRefGoogle Scholar
  43. 43.
    Chan MM, Hamza N, Ammori BJ (2013) Duration of surgery independently influences risk of venous thromboembolism after laparoscopic bariatric surgery. Surg Obes Relat Dis 9:88–93.  https://doi.org/10.1016/j.soard.2011.09.019 CrossRefGoogle Scholar
  44. 44.
    Elli EF, Masrur MA, Giulianotti PC (2013) Robotic sleeve gastrectomy after liver transplantation. Surg Obes Relat Dis 9:e20–e22.  https://doi.org/10.1016/j.soard.2012.01.010 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryThe George Washington University HospitalWashingtonUSA
  2. 2.Department of SurgeryThe Johns Hopkins UniversityBaltimoreUSA

Personalised recommendations