Skip to main content
SpringerLink
Log in

Evolution of Bariatric Robotic Surgery: Revolutionizing Weight Loss Procedures

  • Robotic Surgery (E. Berber, Section Editor)
  • Published:
Current Surgery Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review the historical development of bariatric surgery and how robotic technology has transformed the field. This review will also address the current state of bariatric robotic surgery, including the latest advancements in technology and techniques. It will discuss the evidence supporting robotics in weight loss surgery and the impact on patient outcomes and recovery.

Recent Findings

There is a trend showing that the robotic approach is effective in patients with a high BMI, previous gastrointestinal surgeries and for revisional bariatric surgery. Moreover, it has shown less conversion rates and postoperative complications due to the enhanced visualization and precision to perform meticulous dissections, which is important in cases where anatomy may be challenging.

Summary

The future of bariatric robotic surgery holds significant promise for enhancing patient outcomes and transforming weight loss procedures due to continuing innovations and growing competence in this field.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •Of importance, ••Of major importance

  1. Cadiere G-B, Himpens J, Vertruyen M, Favretti F. The world’s first obesity surgery performed by a surgeon at a distance. Obes Surg. 1999;9(2):206–9.

    Article  CAS  PubMed  Google Scholar 

  2. Shah J, Vyas A, Vyas D. The history of robotics in surgical specialties. Am J Robotic Surg. 2014;1(1):12–20.

    Article  Google Scholar 

  3. Lanfranco AR, Castellanos AE, Desai JP, Meyers WC. Robotic surgery: a current perspective. Ann Surg. 2004;239(1):14.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ozmen M, Gundogdu E, Guldogan E. The current role of robotics in bariatric surgery. Minerva Surg. 2021;76(1):24–32.

    Article  PubMed  Google Scholar 

  5. Chang YW, Lee HY, Kim WY, Kim HY, Lee JB, Son GS. Detailed comparison of the da Vinci Xi and S surgical systems for transaxillary thyroidectomy. Medicine. 2021;100(3).

  6. Ngu JC-Y, Tsang CB-S, Koh DC-S. The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery. Robotic Surgery: Research and Reviews. 2017:77–85.

  7. Giffen Z, Ezzone A, Ekwenna O. Robotic stapler use: Is it safe?–FDA database analysis across multiple surgical specialties. PLoS ONE. 2021;16(6): e0253548.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Holzmacher JL, Luka S, Aziz M, Amdur RL, Agarwal S, Obias V. The use of robotic and laparoscopic surgical stapling devices during minimally invasive colon and rectal surgery: a comparison. J Laparoendosc Adv Surg Tech. 2017;27(2):151–5.

    Article  Google Scholar 

  9. Diana M, Marescaux J. Robotic surgery. J Br Surg. 2015;102(2):e15–28.

    Article  CAS  Google Scholar 

  10. Hanly EJ, Talamini MA. Robotic abdominal surgery. Am J Surg. 2004;188(4):19–26.

    Article  Google Scholar 

  11. Conner J, Nottingham JM. Biliopancreatic diversion with duodenal switch. 2020.

  12. Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998;8(3):267–82.

    Article  CAS  PubMed  Google Scholar 

  13. Gagner M, Ramos A, Palermo M, Noel P, Nocca D. The perfect Sleeve gastrectomy: a clinical guide to evaluation treatment and techniques. Cham: Springer; 2020.

    Book  Google Scholar 

  14. Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15(5):288–98.

    Article  PubMed  Google Scholar 

  15. The Lancet Gastroenterology & Hepatology. Obesity another ongoing pandemic. Lancet Gastroenterol Hepatol. 2021;6:411.

    Article  Google Scholar 

  16. Benaiges D, Más-Lorenzo A, Goday A, Ramon JM, Chillarón JJ, Pedro-Botet J, et al. Laparoscopic sleeve gastrectomy: more than a restrictive bariatric surgery procedure? World J Gastroenterol. 2015;21(41):11804.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Kheirvari M, Nikroo ND, Jaafarinejad H, Farsimadan M, Eshghjoo S, Hosseini S, et al. The advantages and disadvantages of sleeve gastrectomy; clinical laboratory to bedside review. Heliyon. 2020;6(2):e03496.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376(7):641–51.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Affinati AH, Esfandiari NH, Oral EA, Kraftson AT. Bariatric surgery in the treatment of type 2 diabetes. Curr DiabRep. 2019;19:1–10.

    Google Scholar 

  20. •Esquivel CM, Garcia M, Armando L, Ortiz G, Lascano FM, Foscarini JM. Laparoscopic sleeve gastrectomy resolves NAFLD: another formal indication for bariatric surgery? Obesity surgery. 2018;28:4022–33. This article was important for the review since it supports the notion that sleeve gastrectomy is a feasible treatment for NAFLD.

  21. Sarwar R, Pierce N, Koppe S. Obesity and nonalcoholic fatty liver disease: current perspectives. Diabetes, Metab Syndr Obes: Targets Ther. 2018;11:533–42.

    Article  CAS  Google Scholar 

  22. Salman MA, Salman AA, Abdelsalam A, Atallah M, Shaaban HE-D, El-Mikkawy A, et al. Laparoscopic sleeve gastrectomy on the horizon as a promising treatment modality for NAFLD. Obes Surg. 2020;30:87–95.

    Article  PubMed  Google Scholar 

  23. Ahmed Z, Khan MA, Vazquez-Montesino LM, Ahmed A. Bariatric surgery, obesity and liver transplantation. Transl Gastroenterol Hepatol. 2022;7:25.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ayloo S, Guss C, Pentakota SR, Hanna J, Molinari M. Minimally invasive sleeve gastrectomy as a surgical treatment for nonalcoholic fatty liver disease in liver transplant recipients. Transplant proceed. 2020;52:283.

    Article  Google Scholar 

  25. Galetta D, Casiraghi M, Pardolesi A, Borri A, Spaggiari L. New stapling devices in robotic surgery. J Vis Surg. 2017;3:45.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hagen ME, Jung MK, Fakhro J, Buchs NC, Buehler L, Mendoza JM, et al. Robotic versus laparoscopic stapling during robotic Roux-en-Y gastric bypass surgery: a case-matched analysis of costs and clinical outcomes. Surg Endosc. 2018;32:472–7.

    Article  PubMed  Google Scholar 

  27. Chen K, Shiomi A, Kagawa H, Hino H, Manabe S, Yamaoka Y, et al. Efficacy of a robotic stapler on symptomatic anastomotic leakage in robotic low anterior resection for rectal cancer. Surg Today. 2022;52(1):120–8.

    Article  PubMed  Google Scholar 

  28. Magouliotis DE, Tasiopoulou VS, Sioka E, Zacharoulis D. Robotic versus laparoscopic sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis. Obes Surg. 2017;27:245–53.

    Article  PubMed  Google Scholar 

  29. Bauerle WB, Mody P, Estep A, Stoltzfus J, El Chaar M. Current trends in the utilization of a robotic approach in the field of bariatric surgery. Obes Surg. 2023;33(2):482–91.

    Article  PubMed  Google Scholar 

  30. ••Romero RJ, Kosanovic R, Rabaza JR, Seetharamaiah R, Donkor C, Gallas M, et al. Robotic sleeve gastrectomy: experience of 134 cases and comparison with a systematic review of the laparoscopic approach. Obesity surgery. 2013;23:1743–52. This article was important for the review since it shows data in regards of postoperative complications, operative time, and length of stay of laparoscopic and robotic sleeve gastrectomy supporting the topic that we are discussing in this article.

  31. ••Elli E, Gonzalez-Heredia R, Sarvepalli S, Masrur M. Laparoscopic and robotic sleeve gastrectomy: short-and long-term results. Obesity Surgery. 2015;25:967–74. This article was important for the review since it shows data in regards of postoperative complications, operative time, and length of stay of patients that underwent laparoscopic and robotic sleeve gastrectomy thus supporting the topic that we are discussing in this article.

  32. Köckerling F. Robotic vs. standard laparoscopic technique–what is better? Front Surg. 2014;1:15.

    PubMed  PubMed Central  Google Scholar 

  33. Acevedo E, Mazzei M, Zhao H, Lu X, Soans R, Edwards MA. Outcomes in conventional laparoscopic versus robotic-assisted primary bariatric surgery: a retrospective, case–controlled study of the MBSAQIP database. Surg Endosc. 2020;34:1353–65.

    Article  PubMed  Google Scholar 

  34. •Bhatia P, Bindal V, Singh R, Gonzalez-Heredia R, Kalhan S, Khetan M, et al. Robot-assisted sleeve gastrectomy in morbidly obese versus super obese patients. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2014;18(3). This article was important for the review since it shows data supporting that robotic sleeve gastrectomy is beneficial in patients with a high BMI.

  35. ••Elli EF, Masrur MA, Giulianotti PC. Robotic sleeve gastrectomy after liver transplantation. Surgery for Obesity and Related Diseases. 2013;9(1):e20-e2. This article was important for the review since it shows data supporting the fact that robotic sleeve gastrectomy is beneficial in patients with a previous liver transplant and previous gastrointestinal surgeries.

  36. Ortenzi M, Ghiselli R, Baldarelli M, Cardinali L, Guerrieri M. Is the bipolar vessel sealer device an effective tool in robotic surgery? A retrospective analysis of our experience and a meta-analysis of the literature about different robotic procedures by investigating operative data and post-operative course. Minim Invasive Ther Allied Technol. 2018;27(2):113–8.

    Article  PubMed  Google Scholar 

  37. •Horgan S, Vanuno D. Robots in laparoscopic surgery. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2001;11(6):415–9. This article was important for the initial experience of robotic surgery in bariatric, foregut, and adrenal surgery procedures.

  38. Moser F, Horgan S. Robotically assisted bariatric surgery. Am J Surg. 2004;188(4):38–44.

    Article  Google Scholar 

  39. Mohr CJ, Nadzam GS, Curet MJ. Totally robotic Roux-en-Y gastric bypass. Arch Surg. 2005;140(8):779–86.

    Article  PubMed  Google Scholar 

  40. Higa KD, Ho T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech A. 2001;11(6):377–82.

    Article  CAS  PubMed  Google Scholar 

  41. Sanchez BR, Mohr CJ, Morton JM, Safadi BY, Alami RS, Curet MJ. Comparison of totally robotic laparoscopic Roux-en-Y gastric bypass and traditional laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005;1(6):549–54.

    Article  PubMed  Google Scholar 

  42. Buchs NC, Pugin F, Bucher P, Hagen ME, Chassot G, Koutny-Fong P, et al. Learning curve for robot-assisted Roux-en-Y gastric bypass. Surg Endosc. 2012;26(4):1116–21.

    Article  PubMed  Google Scholar 

  43. Kauffels A, Reichert M, Askevold I, Bender A, Hecker A, Padberg W, et al. Establishing robotic bariatric surgery at an academic tertiary hospital: a learning curve analysis for totally robotic Roux-en-Y gastric bypass. J Robot Surg. 2023;17(2):577–85.

    Article  PubMed  Google Scholar 

  44. Beckmann JH, Bernsmeier A, Kersebaum JN, Mehdorn AS, von Schönfels W, Taivankhuu T, et al. The impact of robotics in learning Roux-en-Y gastric bypass: a retrospective analysis of 214 laparoscopic and robotic procedures : robotic Vs. Laparoscopic RYGB Obes Surg. 2020;30(6):2403–10.

    Article  PubMed  Google Scholar 

  45. ••Coker A, Sebastian R, Tatum J, Cornejo J, Zevallos A, Li C, et al. Do advances in technology translate to improved outcomes? Comparing robotic bariatric surgery outcomes over two-time intervals utilizing the MBSAQIP database. Surg Endosc. 2023;37(10):7970-9. This article was important because it describes the improvement of outcomes in robotic bariatric surgery when compared two time frames (2015-2016 vs 2019-2020) using the largest bariatric registry database of US and Canada (MBSAQIP)

  46. Senellart P, Saint-Jalmes G, Mfam WS, Abou-Mrad A. Laparoscopic versus full robotic Roux-en-Y gastric bypass: retrospective, single-center study of the feasibility and short-term results. J Robot Surg. 2020;14(2):291–6.

    Article  PubMed  Google Scholar 

  47. Sebastian R, Howell MH, Chang KH, Adrales G, Magnuson T, Schweitzer M, et al. Robot-assisted versus laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a propensity score-matched comparative analysis using the 2015–2016 MBSAQIP database. Surg Endosc. 2019;33(5):1600–12.

    Article  PubMed  Google Scholar 

  48. Leang YJ, Mayavel N, Yang WTW, Kong JCH, Hensman C, Burton PR, et al. Robotic versus laparoscopic gastric bypass in bariatric surgery: a systematic review and meta-analysis on perioperative outcomes. Surg Obes Relat Dis. 2023;20:62.

    Article  PubMed  Google Scholar 

  49. Niclauss N, Morel P, Jung MK, Hagen MEA. comparison of the da Vinci Xi vs. the da Vinci Si surgical system for Roux-en-Y gastric bypass. Langenbecks Arch Surg. 2019;404(5):615–20.

    Article  PubMed  Google Scholar 

  50. Rodríguez-Luna MR, Vilallonga R, Roriz-Silva R, Rangarajan M, Ruiz G, de Gordejuela A, Caubet E, et al. A comparison of clinical outcomes between two different models of surgical robots in Roux-en-Y gastric bypass. J Laparoendosc Adv Surg Tech A. 2021;31(9):969–77.

    Article  PubMed  Google Scholar 

  51. Roriz-Silva R, Vilallonga R, Fort JM, Khoraki J, de Gordejuela AGR, Gonzalez O, et al. Robotic and laparoscopic Roux-en-Y gastric bypass after learning curve: 30-day and 12-month outcomes. J Robot Surg. 2022;16(6):1257–63.

    Article  PubMed  Google Scholar 

  52. ••Sebastian R, Ghanem OM, Cornejo J, Ruttger T, Mayuiers M, Adrales G, et al. Robot-assisted versus laparoscopic approach to concurrent bariatric surgery and hiatal hernia repair: propensity score matching analysis using the 2015–2018 MBSAQIP. Surg Endosc. 2022;36(9):6886–95. This article was important because it describes the relevance of the robotic platform in complex surgeries such as concomitant hiatal hernia repair during primary RYGB when compared to the laparoscopic approach.

  53. Sudan R, Puri V, Sudan D. Robotically assisted biliary pancreatic diversion with a duodenal switch: a new technique. Surg Endosc. 2007;21(5):729–33.

    Article  CAS  PubMed  Google Scholar 

  54. ••Sudan R, Podolsky E. Totally robot-assisted biliary pancreatic diversion with duodenal switch: single dock technique and technical outcomes. Surg Endosc. 2015;29(1):55–60.

    Article  PubMed  Google Scholar 

  55. Sudan R, Bennett KM, Jacobs DO, Sudan DL. Multifactorial analysis of the learning curve for robot-assisted laparoscopic biliopancreatic diversion with duodenal switch. Ann Surg. 2012;255(5):940–5.

    Article  PubMed  Google Scholar 

  56. Teixeira A, Jawad M, Ghanem M, Sánchez A, Petrola C, Lind R. Analysis of the impact of the learning curve on the safety outcome of the totally robotic-assisted biliopancreatic diversion with duodenal switch: a single-institution observational study. Obes Surg. 2023;33(9):2742–8.

    Article  PubMed  Google Scholar 

  57. Teixeira A, Jawad M, Ghanem M, Sanchez A, Inchausti C, Mogollon I, et al. Robot-assisted duodenal switch with DaVinci Xi: surgical technique and analysis of a single-institution experience of 661 cases. J Robot Surg. 2023;17(3):923–31.

    Article  PubMed  Google Scholar 

  58. Al-Mazrou AM, Cruz MV, Dakin G, Bellorin-Marin OE, Pomp A, Afaneh C. Robotic duodenal switch is associated with outcomes comparable to those of laparoscopic approach. Obes Surg. 2021;31(5):2019–29.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Kissler HJ, Settmacher U. Bariatric surgery to treat obesity. Semin Nephrol. 2013;33(1):75–89.

    Article  PubMed  Google Scholar 

  60. Switzer NJ, Karmali S, Gill RS, Sherman V. Revisional bariatric surgery. Surg Clin North Am. 2016;96(4):827–42.

    Article  PubMed  Google Scholar 

  61. Suter M, Calmes JM, Paroz A, Giusti V. A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Obes Surg. 2006;16(7):829–35.

    Article  CAS  PubMed  Google Scholar 

  62. Gagner M, Gentileschi P, de Csepel J, Kini S, Patterson E, Inabnet WB, et al. Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg. 2002;12(2):254–60.

    Article  PubMed  Google Scholar 

  63. Mittermair RP, Obermüller S, Perathoner A, Sieb M, Aigner F, Margreiter R. Results and complications after swedish adjustable gastric banding-10 years experience. Obes Surg. 2009;19(12):1636–41.

    Article  PubMed  Google Scholar 

  64. Elnahas A, Graybiel K, Farrokhyar F, Gmora S, Anvari M, Hong D. Revisional surgery after failed laparoscopic adjustable gastric banding: a systematic review. Surg Endosc. 2013;27(3):740–5.

    Article  PubMed  Google Scholar 

  65. Li S, Jiao S, Zhang S, Zhou J. Revisional surgeries of laparoscopic sleeve gastrectomy. Diabetes Metab Syndr Obes. 2021;14:575–88.

    Article  PubMed  PubMed Central  Google Scholar 

  66. ••Cheng YL, Elli EF. Role of Robotic Surgery in Complex Revisional Bariatric Procedures. Obes Surg. 2021;31(6):2583–9. This article was important for the review since it shows the most common treatments performed nowadays for revisional bariatric surgery, supporting the topic that we are discussing in this article.

  67. Abu Dayyeh B, Portela R, Mahmoud T, Ghazi R, Ghanem OM. A novel approach for weight regain after Roux-en-Y gastric bypass: Staged transoral outlet reduction (TORe) followed by surgical type 1 distalization. VideoGIE. 2022;7(4):135–7.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Borjas G, Sánchez N, Urdaneta A, Maldonado A, Ramos E, Fumero E, et al. 2022; Hybrid revisional surgery: biliary limb distalization plus endoscopic transoral outlet reduction (eTOR). J Surg Case Rep. 2022;5:177.

    Article  Google Scholar 

  69. Darzi SA, Munz Y. The impact of minimally invasive surgical techniques. Annu Rev Med. 2004;55:223–37.

    Article  CAS  PubMed  Google Scholar 

  70. •Xie J, Dreifuss NH, Schlottmann F, Cubisino A, Mangano A, Vanetta C, et al. Minimally Invasive Revisional Bariatric Surgery in a MBSAQIP Accredited High-Volume Center. Front Surg. 2022 9:880044. This article was important for the review since it shows data in regards of reoperation rate and postoperative complications as well as the benefits of the robotic approach in revisional bariatric surgery, supporting the topic that we are discussing in this article.

  71. ••Castillo-Larios R, Cornejo J, Gunturu NS, Cheng YL, Elli EF. Experience of Robotic Complex Revisional Bariatric Surgery in a High-Volume Center. Obes Surg. 2023;33(12):4034–41. This article was important for the review since it shows data in regards of reoperation rate and postoperative complications the benefits of the robotic approach in complex cases in revisional bariatric surgery, supporting the topic that we are discussing in this article.

  72. ••El Chaar M, King K, Pastrana M, Galvez A, Stoltzfus J. Outcomes of robotic surgery in revisional bariatric cases: a propensity score-matched analysis of the MBSAQIP registry. J Robot Surg. 2021;15(2):235–9. This article was important for the review since it shows data in regards of the benefits of the robotic approach in revisional bariatric surgery. It also explains certain aspects of the increased operative time while using the robotic approach.

  73. Nasser H, Munie S, Kindel TL, Gould JC, Higgins RM. Comparative analysis of robotic versus laparoscopic revisional bariatric surgery: perioperative outcomes from the MBSAQIP database. Surg Obes Relat Dis. 2020;16(3):397–405.

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was received.

Author information

Authors and Affiliations

  1. Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    Lorna Evans, Jorge Cornejo & Enrique F. Elli

Authors
  1. Lorna Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jorge Cornejo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Enrique F. Elli
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization L.A.E, J.C., E.F.E Data curation L.A.E., J.C. Investigation L.A.E., J.C Methodology L.A.E, J.C.,E.F.E. Project administration, E.FE. Supervision, E.F.E. Validation E.F.E. Writing-original draft L.A.E., J.C. Writing-review & editing L.A.E., J.C., E.F.E All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Enrique F. Elli.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interests with respect to authorship or publication of this manuscript.

Research Involving Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Evans, L., Cornejo, J. & Elli, E.F. Evolution of Bariatric Robotic Surgery: Revolutionizing Weight Loss Procedures. Curr Surg Rep (2024). https://doi.org/10.1007/s40137-024-00398-9

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40137-024-00398-9

Keywords

Search

Navigation