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Robotic bariatric surgery for the obesity: a systematic review and meta-analysis

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Abstract

Objective

The aim of this meta-analysis is to evaluate the safety and efficacy of bariatric surgery (BS) in patients with obesity by robotic bariatric surgery (RBS) compared with laparoscopic bariatric surgery (LBS).

Methods

The study was performed through searching in Pubmed, Web of Science, Embase database and Cochrane Library until March 31, 2020 comparing RBS with LBS. Data were calculated on the following endpoints: operative time, length of hospital stay, reoperation within 30 days, overall complications, leak, stricture, pulmonary embolisms, estimated blood loss and mortality. Data as relative risks (OR), or weighted mean difference (WMD) were summarized with 95% confidence interval (CI). Risk of publication bias was assessed through standard methods.

Results

Thirty eligible trials including 7,239 robotic and 203,181 laparoscopic surgery cases showed that RBS was referred to attain longer operative time [WMD = 27.61 min; 95%CI (16.27–38.96); P < 0.01] and lower mortality [OR 2.40; 95% CI (1.24–4.64); P = 0.009] than LBS. Length of hospital stay [WMD = − 0.02; 95% CI (− 0.19–0.15); P = 0.819], reoperation within 30 days [OR 1.36; 95% CI (0.65–2.82); P = 0.411], overall complications [OR 0.88; 95% CI (0.68–1.15); P = 0.362], leak [OR 1.04; 95% CI (0.43–2.51); P = 0.933], stricture [OR 1.05; 95% CI (0.52–2.12); P = 0.895], pulmonary embolisms [OR 1.97; 95% CI (0.93–4.17); P = 0.075], estimated blood loss[WMD = − 1.93; 95% CI (− 4.61–0.75); P = 0.158] were almost similar in both RBS group and LBS group. Three was no statistically significant difference between RRYGB and LRYGB in EWL%, no statistical significance between RSG and LSG after 1 year, 2 years and 3 years.

Conclusion

RBS presented lower mortality within 90 days and longer operative time in this meta-analysis with similar safety and efficacy for the obesity compared with LBS in other outcomes. Additionally, RBS might be beneficial in the future if it would be evaluated in comprehensive and long-term endpoints.

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References

  1. Ng M, Fleming T, Robinson M et al (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013:a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384:766–781

    Article  PubMed  PubMed Central  Google Scholar 

  2. Courcoulas AP, Christian NJ, Belle SH et al (2013) Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA 310(22):2416–2425

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Mingrone G, Panunzi S, De Gaetano A et al (2015) Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomized controlled trial. Lancet 386:964–973

    Article  PubMed  Google Scholar 

  4. Puzziferri N, Roshek III TB, Mayo HG et al (2014) Long-term follow-up after bariatric surgery a systematic review. JAMA 312(9):934–942

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Schauer PR, Bhatt DL, Kirwan JP et al (2014) Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med 370:2002–2013

    Article  PubMed  PubMed Central  Google Scholar 

  6. Li K, Zou J, Tang J et al (2016) Robotic versus laparoscopic bariatric surgery: a systematic review and meta-analysis. Obes Surg 26(12):3031–3044

    Article  PubMed  Google Scholar 

  7. Economopoulos KP, Theocharidis V, McKenzie TJ et al (2015) Robotic vs laparoscopic Roux-En-y gastric bypass: a systematic review and meta-analysis. Obes Surg. 25(11):2180–2189

    Article  PubMed  Google Scholar 

  8. Magouliotis DE, Tasiopoulou VS, Sioka E et al (2017) Robotic versus laparoscopic sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis. OBES SURG 27:245–253

    Article  PubMed  Google Scholar 

  9. Huang YM, Huang YJ, Wei PL (2017) Outcomes of robotic versus laparoscopic surgery for mid and low rectal cancer after neoadjuvant chemoradiation therapy and the effect of learning curve. Medicine 96:40

    Article  Google Scholar 

  10. Li X, Wang T, Yao L et al (2017) The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer A meta-analysis and systematic review. Medicine 96:29

    Google Scholar 

  11. Ahmad A, Carleton JD, Ahmad ZF et al (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

    Article  PubMed  Google Scholar 

  12. Ayloo SM, Addeo P, Buchs NC et al (2011) Robot-assisted versus laparoscopic Roux-en-Y gastric bypass: is there a difference in outcomes? World J Surg 35:637–642

    Article  PubMed  Google Scholar 

  13. Benizri EI, Renaud M, Reibel N et al (2013) Perioperative outcomes after totally robotic gastric bypass: a prospective nonrandomized controlled study. Am J Surgery 206:145–151

    Article  Google Scholar 

  14. Buchs NC, Morel P, Azagury DE et al (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

    Article  PubMed  Google Scholar 

  15. Celio AC, Kasten KR, Schwoerer A et al (2017) Perioperative safety of laparoscopic versus robotic gastric bypass: a propensity matched analysis of early experience. Surg Obes Relat Dis 13(11):1847–1852

    Article  PubMed  Google Scholar 

  16. Curet MJ, Curet M, Solomon H et al (2009) Comparison of hospital charges between robotic, laparoscopic stapled, and laparoscopic handsewn Roux-en-Y gastric bypass. J Robotic Surg 3:75–78

    Article  Google Scholar 

  17. Hubens G, Balliu L, Ruppert M et al (2008) Roux-en-Y gastric bypass procedure performed with the da Vinci robot system: is it worth it? Surg Endosc 22:1690–1696

    Article  CAS  PubMed  Google Scholar 

  18. Lyn-Sue JR, Winder JS, Kotch S, et al. (2016) Laparoscopic gastric bypass to robotic gastric bypass: time and cost commitment involved in training and transitioning an academic surgical practice. J Robotic Surg 10:111–115

    Article  Google Scholar 

  19. Mohr CJ, Nadzam GS, Curet MJ et al (2005) Totally robotic Roux-en-Y gastric bypass. Arch Surg 140:779–786

    Article  PubMed  Google Scholar 

  20. Moon RC, Gutierrez JC, Royall NA et al (2016) Robotic Roux-en-Y gastric bypass, is it safer than laparoscopic bypass? OBES Surg 26:1016–1020

    Article  PubMed  Google Scholar 

  21. Myers SR, McGuirl J, Wang J (2013) Robot-assisted versus laparoscopic gastric bypass: comparison of short-term outcomes. OBES Surg 23:467–473

    Article  PubMed  Google Scholar 

  22. Park CW, Lam ECF, Walsh TM et al (2011) Robotic-assisted Roux-en-Y gastric bypass performed in a community hospital setting: the future of bariatric surgery? Surg Endosc 25:3312–3321

    Article  PubMed  Google Scholar 

  23. Sanchez BR, Mohr CJ, Morton JM et al (2005) Comparison of totally robotic laparoscopic Roux-en-Y gastric bypass and traditional laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 1(6):549–554

    Article  PubMed  Google Scholar 

  24. Scozzari G, Rebecchi F, Millo P et al (2011) Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass. Surg Endosc 25:597–603

    Article  PubMed  Google Scholar 

  25. Snyder BE, Wilson T, Leong BY et al (2010) Robotic-assisted Roux-en-Y gastric bypass: minimizing morbidity and mortality. OBES Surg 20:265–270

    Article  PubMed  Google Scholar 

  26. Smeenk M, van Hof G, Elsten E et al (2016) The results of 100 robotic versus 100 laparoscopic gastric bypass procedures: a single high volume centre experience. OBES Surg 26:1266–1273

    Article  CAS  PubMed  Google Scholar 

  27. Stefanidis D, Bailey SB, Kuwada T et al (2018) Robotic gastric bypass may lead to fewer complications compared with laparoscopy. Surg Endosc 32(2):610–616

    Article  PubMed  Google Scholar 

  28. Villamere J, Gebhart A, Stephen Vu et al (2015) Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at Academic Medical Centers. Surg Endosc 29:1729–1736

    Article  PubMed  Google Scholar 

  29. Wood MH, Kroll JJ, Garretson B (2016) A comparison of outcomes between the traditional laparoscopic and totally robotic Roux-en-Y gastric bypass procedures. J Robotic Surg 8:29–34

    Article  Google Scholar 

  30. Altieri MS, Yang J, Telem DA et al (2016) Robotic approaches may offer benefit in colorectal procedures, more controversial in other areas: a review of 168,248 cases. Surg Endosc 30:925–933

    Article  PubMed  Google Scholar 

  31. Ayloo S, Buchs NC, Addeo P et al (2011) Robot-assisted sleeve gastrectomy for super-morbidly obese patients. J Laparoendosc Adv Surg Tech A 21(4):295–299

    Article  PubMed  Google Scholar 

  32. Elli E, Gonzalez-Heredia R, Sarvepalli S et al (2015) Laparoscopic and robotic sleeve gastrectomy: short- and long-term results. OBES SURG 25:967–974

    Article  PubMed  Google Scholar 

  33. Kannan U, Ecker BL, Choudhury R (2016) Laparoscopic hand-assisted versus robotic-assisted laparoscopic sleeve gastrectomy: experience of 103 consecutive cases. Surg Obes Relat Dis 12(1):94–99

    Article  PubMed  Google Scholar 

  34. Moon RC, Stephenson D, Royall NA et al (2016) Robot-assisted versus laparoscopic sleeve gastrectomy: learning curve, perioperative, and short-term outcomes. OBES Surg 26:2463–2468

    Article  PubMed  Google Scholar 

  35. Pepper VK, Rager TM, Diefenbach KA et al (2016) Robotic vs. laparoscopic sleeve gastrectomy in adolescents; reality or hype. OBES SURG 26:1912–1917

    Article  PubMed  Google Scholar 

  36. Schraibman V, Macedo ALV, Epstein MG et al (2014) Comparison of the morbidity weight loss, and relative costs between robotic and laparoscopic sleeve gastrectomy for the treatment of obesity in Brazil. OBES Surg 24:1420–1424

    Article  PubMed  Google Scholar 

  37. Vilallonga R, Fort JM, Caubet E et al (2013) robotic sleeve gastrectomy versus laparoscopic sleeve gastrectomy: a comparative study with 200 patients. OBES Surg 23:1501–1507

    Article  PubMed  Google Scholar 

  38. Edelson PK, Dumon KR, Sonnad SS et al (2011) Robotic vs. conventional laparoscopic gastric banding:a comparison of 407 cases. Surg Endosc 25:1402–1408

    Article  PubMed  Google Scholar 

  39. Kang JH, Le QA (2017) Effectiveness of bariatric surgical procedures a systematic review and network meta-analysis of randomized controlled trials. Medicine. 96:46

    Article  Google Scholar 

  40. Lyn-Sue JR, Winder JS, Kotch S et al (2016) Robotic versus laparoscopic bariatric surgery: a systematic review and meta-analysis. J Robot Surg Jun 10(2):111–115

    Article  Google Scholar 

  41. Alibhai MH, Shah SK, Walker PA et al (2015) A review of the role of robotics in bariatric surger. J Surg Oncol. 112(3):279–283

    Article  PubMed  Google Scholar 

  42. Prete FP, Pezzolla A, Prete F et al (2018) Robotic versus laparoscopic minimally invasive surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. Ann Surg 267(6):1034–1046

    Article  PubMed  Google Scholar 

  43. Liang H, Liang W, Zhao L et al (2018) Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: a meta-analysis. Ann Surg 268(2):254–259

    Article  PubMed  Google Scholar 

  44. Acquafresca PA, Palermo M, Rogula T et al (2015) Most common robotic bariatric procedures: review and technical aspects. Ann Surg Innov Res. 28:9

    Article  Google Scholar 

  45. Antanavicius G, Sucandy I (2013) Robotically-assisted laparoscopic biliopancreatic diversion with duodenal switch: the utility of the robotic system in bariatric surgery. J Robotic Surg 7:261–266

    Article  Google Scholar 

  46. Antanavicius G, Rezvani M, Sucandy I (2015) One-stage robotically assisted laparoscopic biliopancreatic diversion with duodenal switch: analysis of 179 patients. Surgery Obes Relat Dis 11:367–371

    Article  Google Scholar 

  47. Fantola G, Reibel N, Germain A et al (2015) Second-stage robot-assisted biliopancreatic diversion with duodenal switch after sleeve gastrectomy. OBES SURG 25:197–198

    Article  CAS  PubMed  Google Scholar 

  48. Sudan R, Bennett KM, Jacobs DO et al (2012) Multifactorial analysis of the learning curve for robot-assisted laparoscopic biliopancreatic diversion with duodenal switch. Ann Surg. 255:940–945

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  50. Ayloo S, Roh Y, Choudhury N (2016) Laparoscopic, hybrid, and totally robotic Roux-en-Y gastric bypass. J Robot Surg 10:41–47

    Article  PubMed  Google Scholar 

  51. Scozzari G, ZaniniM CF et al (2014) High incidence of trocar site hernia after laparoscopic or robotic Roux-en-Y gastric bypass. Surg Endosc 28:2890–2898

    Article  PubMed  Google Scholar 

  52. Buchs NC, Azagury DE, Pugin F et al (2015) Roux-en-Y gastric bypass for super obese patients: what approach? Int J Med Robot Comput Assist Surg 12(2):276–282

    Article  Google Scholar 

  53. Jeong IG, Khandwala YS, Kim JH et al (2017) Association of robotic-assisted vs laparoscopic radical nephrectomy with perioperative outcomes and health care costs, 2003 to 2015. JAMA 318(16):1561–1568

    Article  PubMed  PubMed Central  Google Scholar 

  54. Busetto L, Dicker D, Azran C et al (2017) Practical recommendations of the obesity management task force of the european association for the study of obesity for the post-bariatric surgery medical management. Obes Facts 10:597–632

    Article  PubMed  PubMed Central  Google Scholar 

  55. Parrott J, Frank L, Rabena R et al (2017) American Society for metabolic and bariatric surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 update: micronutrients. Surg Obes Relat Dis 13(5):727–741

    Article  PubMed  Google Scholar 

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Acknowledgements

Yumin Li and Zhengchao Zhang contributed to study concept and design; Zhengchao Zhang, Lele Miao and Zhijian Ren contributed to literature search, review of the studies, and data extractions. Zhengchao Zhang contributed to data analysis and data interpretation. Lele Miao and Zhijian Ren contributed to verify the statistical analysis and scrutinized data. Yumin Li provided expert insight. Yumin Li contributed to supervision throughout the whole study. All the authors contributed writing the manuscript. All authors approved the final version of the manuscript.

Funding

This study is funded by the National Natural Science Foundation of China (Project Approval Number: 31770537) and Special Research Project of Lanzhou University Serving the Economic and Social Development of Gansu Province (054000282).

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Authors and Affiliations

  1. Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, China

    Zhengchao Zhang, Lele Miao, Zhijian Ren & Yumin Li

  2. Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou, 730000, China

    Zhengchao Zhang, Lele Miao, Zhijian Ren & Yumin Li

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  1. Zhengchao Zhang
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Correspondence to Yumin Li.

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Zhengchao Zhang, Lele Miao, Zhijian Ren, and Yumin Li have declare that they have no competing interests.

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Zhang, Z., Miao, L., Ren, Z. et al. Robotic bariatric surgery for the obesity: a systematic review and meta-analysis. Surg Endosc 35, 2440–2456 (2021). https://doi.org/10.1007/s00464-020-08283-z

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