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Robotic-Assisted Versus Laparoscopic Revisional Bariatric Surgery: a Systematic Review and Meta-analysis on Perioperative Outcomes

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Abstract

This systematic review and meta-analysis investigated the role of robotic-assisted surgery in patients undergoing revisional bariatric surgery (RBS). According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search of PubMed, Cochrane Library, Web of Science, and Google Scholar was performed: ((“sleeve”AND “gastr*”)OR “bariatric”OR “gastric bypass”)AND(“robot*”OR “DaVinci”OR “Da Vinci”)AND(“revision*”OR “conversion*”). In this review, six studies with 29,890 patients were included (2459 in the robotic group). No difference in postoperative complications (RR 1.070, 95%CI 0.930–1.231, p = 0.950), conversions to open surgery (RR 1.339, 95%CI 0.736–2.438, p = 0.339), length of stay (SMD − 0.041, 95%CI − 0.420–0.337, p = 0.831) or operative time (RR 0.219, 95%CI − 0.539–0.977, p = 0.571) was found. This systematic review and meta-analysis showed no significant advantage of robotic-assisted RBS; on the other hand, it showed a non-inferior efficacy compared to standard laparoscopy.

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References

  1. Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Nanni G, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964–73. https://doi.org/10.1016/s0140-6736(15)00075-6.

    Article  PubMed  Google Scholar 

  2. English WJ, DeMaria EJ, Hutter MM, Kothari SN, Mattar SG, Brethauer SA, et al. American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis. 2020;16(4):457–63. https://doi.org/10.1016/j.soard.2019.12.022.

    Article  PubMed  Google Scholar 

  3. Altieri MS, Yang J, Nie L, Blackstone R, Spaniolas K, Pryor A. Rate of revisions or conversion after bariatric surgery over 10 years in the state of New York. Surg Obes Relat Dis. 2018;14(4):500–7. https://doi.org/10.1016/j.soard.2017.12.019.

    Article  PubMed  Google Scholar 

  4. Zhang L, Tan WH, Chang R, Eagon JC. Perioperative risk and complications of revisional bariatric surgery compared to primary Roux-en-Y gastric bypass. Surg Endosc. 2015;29(6):1316–20. https://doi.org/10.1007/s00464-014-3848-4.

    Article  PubMed  Google Scholar 

  5. Inabnet WB 3rd, Belle SH, Bessler M, Courcoulas A, Dellinger P, Garcia L, et al. Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study. Surg Obes Relat Dis. 2010;6(1):22–30. https://doi.org/10.1016/j.soard.2009.10.007.

    Article  PubMed  Google Scholar 

  6. Shimizu H, Annaberdyev S, Motamarry I, Kroh M, Schauer PR, Brethauer SA. Revisional bariatric surgery for unsuccessful weight loss and complications. Obes Surg. 2013;23(11):1766–73. https://doi.org/10.1007/s11695-013-1012-1.

    Article  PubMed  Google Scholar 

  7. Cheung D, Switzer NJ, Gill RS, Shi X, Karmali S. Revisional bariatric surgery following failed primary laparoscopic sleeve gastrectomy: a systematic review. Obes Surg. 2014;24(10):1757–63. https://doi.org/10.1007/s11695-014-1332-9.

    Article  PubMed  Google Scholar 

  8. Zhang Z, Miao L, Ren Z, Li Y. Robotic bariatric surgery for the obesity: a systematic review and meta-analysis. Surg Endosc. 2021;35(6):2440–56. https://doi.org/10.1007/s00464-020-08283-z.

    Article  PubMed  Google Scholar 

  9. Alibhai MH, Shah SK, Walker PA, Wilson EB. A review of the role of robotics in bariatric surgery. J Surg Oncol. 2015;112(3):279–83. https://doi.org/10.1002/jso.23913.

    Article  PubMed  Google Scholar 

  10. Pini R, Mongelli F, Proietti F, Cianfarani A, Garofalo F, Di Giuseppe M, et al. Suture and fixation of the transversalis fascia during robotic-assisted transabdominal preperitoneal hernia repair to prevent seroma formation after direct inguinal hernia repair. Surg Innov. 2021;28(3):284–9. https://doi.org/10.1177/1553350620960976.

  11. Moher D, Liberati A, Tetzlaff J, Altman DG. Reprint–preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther. 2009;89(9):873–80.

    Article  PubMed  Google Scholar 

  12. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343: d5928. https://doi.org/10.1136/bmj.d5928.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401–6. https://doi.org/10.1016/j.jclinepi.2010.07.015.

    Article  PubMed  Google Scholar 

  14. Walter SD, Yao X. Effect sizes can be calculated for studies reporting ranges for outcome variables in systematic reviews. J Clin Epidemiol. 2007;60(8):849–52. https://doi.org/10.1016/j.jclinepi.2006.11.003.

    Article  PubMed  CAS  Google Scholar 

  15. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135. https://doi.org/10.1186/1471-2288-14-135.

    Article  PubMed  PubMed Central  Google Scholar 

  16. DerSimonian R, Laird N. Meta-analysis in clinical trials revisited. Contemp Clin Trials. 2015;45(Pt A):139–45. https://doi.org/10.1016/j.cct.2015.09.002.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58. https://doi.org/10.1002/sim.1186.

    Article  PubMed  Google Scholar 

  18. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. https://doi.org/10.1136/bmj.327.7414.557.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34. https://doi.org/10.1136/bmj.315.7109.629.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Buchs NC, Pugin F, Azagury DE, Huber O, Chassot G, Morel P. Robotic revisional bariatric surgery: a comparative study with laparoscopic and open surgery. Int J Med Robot. 2014;10(2):213–7. https://doi.org/10.1002/rcs.1549.

    Article  PubMed  Google Scholar 

  21. Gray KD, Moore MD, Elmously A, Bellorin O, Zarnegar R, Dakin G, et al. Perioperative outcomes of laparoscopic and robotic revisional bariatric surgery in a complex patient population. Obes Surg. 2018;28(7):1852–9. https://doi.org/10.1007/s11695-018-3119-x.

    Article  PubMed  Google Scholar 

  22. 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. https://doi.org/10.1016/j.soard.2019.11.018.

    Article  PubMed  Google Scholar 

  23. King K, Galvez A, Stoltzfus J, Claros L, El Chaar M. Robotic-assisted surgery results in a shorter hospital stay following revisional bariatric surgery. Obes Surg. 2021;31(2):634–9. https://doi.org/10.1007/s11695-020-05022-0.

    Article  PubMed  Google Scholar 

  24. Moon RC, Segura AR, Teixeira AF, Jawad MA. Feasibility and safety of robot-assisted bariatric conversions and revisions. Surg Obes Relat Dis. 2020;16(8):1080–5. https://doi.org/10.1016/j.soard.2020.03.030.

    Article  PubMed  Google Scholar 

  25. Beckmann JH, Mehdorn AS, Kersebaum JN, von Schönfels W, Taivankhuu T, Laudes M, et al. Pros and cons of robotic revisional bariatric surgery. Visc Med. 2020;36(3):238–45. https://doi.org/10.1159/000507742.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Fulton C, Sheppard C, Birch D, Karmali S, de Gara C. A comparison of revisional and primary bariatric surgery. Can J Surg. 2017;60(3):205–11. https://doi.org/10.1503/cjs.006116.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Moszkowicz D, Rau C, Guenzi M, Zinzindohoué F, Berger A, Chevallier JM. Laparoscopic omega-loop gastric bypass for the conversion of failed sleeve gastrectomy: early experience. J Visc Surg. 2013;150(6):373–8. https://doi.org/10.1016/j.jviscsurg.2013.08.010.

    Article  PubMed  CAS  Google Scholar 

  28. Musella M, Bruni V, Greco F, Raffaelli M, Lucchese M, Susa A, et al. Conversion from laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) to one anastomosis gastric bypass (OAGB): preliminary data from a multicenter retrospective study. Surg Obes Relat Dis. 2019;15(8):1332–9. https://doi.org/10.1016/j.soard.2019.05.026.

    Article  PubMed  Google Scholar 

  29. Piazza L, Di Stefano C, Ferrara F, Bellia A, Vacante M, Biondi A. Revision of failed primary adjustable gastric banding to mini-gastric bypass: results in 48 consecutive patients. Updates Surg. 2015;67(4):433–7. https://doi.org/10.1007/s13304-015-0335-y.

    Article  PubMed  Google Scholar 

  30. Lauti M, Kularatna M, Hill AG, MacCormick AD. Weight regain following sleeve gastrectomy-a systematic review. Obes Surg. 2016;26(6):1326–34. https://doi.org/10.1007/s11695-016-2152-x.

    Article  PubMed  Google Scholar 

  31. Brethauer SA, Kothari S, Sudan R, Williams B, English WJ, Brengman M, et al. Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis. 2014;10(5):952–72. https://doi.org/10.1016/j.soard.2014.02.014.

    Article  PubMed  Google Scholar 

  32. Mor A, Keenan E, Portenier D, Torquati A. Case-matched analysis comparing outcomes of revisional versus primary laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2013;27(2):548–52. https://doi.org/10.1007/s00464-012-2477-z.

    Article  PubMed  Google Scholar 

  33. Di Giuseppe M, Mongelli F, Marcantonio M, La Regina D, Pini R. Robotic assisted treatment of flank hernias: case series. BMC Surg. 2020;20(1):184. https://doi.org/10.1186/s12893-020-00843-3.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Pini R, Di Giuseppe M, Toti JMA, Mongelli F, Marcantonio M, Spampatti S, et al. Robot-assisted treatment of epigastric hernias with a suprapubic approach. Surg Laparosc Endosc Percutan Tech. 2021. https://doi.org/10.1097/sle.0000000000000941.

    Article  PubMed  Google Scholar 

  35. Rebecchi F, Ugliono E, Allaix ME, Toppino M, Borello A, Morino M. Robotic Roux-en-Y gastric bypass as a revisional bariatric procedure: a single-center prospective cohort study. Obes Surg. 2020;30(1):11–7. https://doi.org/10.1007/s11695-019-04117-7.

    Article  PubMed  Google Scholar 

  36. Acevedo E, Mazzei M, Zhao H, Lu X, Edwards MA. Outcomes in conventional laparoscopic versus robotic-assisted revisional bariatric surgery: a retrospective, case-controlled study of the MBSAQIP database. Surg Endosc. 2020;34(4):1573–84. https://doi.org/10.1007/s00464-019-06917-5.

    Article  PubMed  Google Scholar 

  37. 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. https://doi.org/10.1007/s11701-020-01098-z.

    Article  PubMed  Google Scholar 

  38. Dreifuss NH, Mangano A, Hassan C, Masrur MA. Robotic revisional bariatric surgery: a high-volume center experience. Obes Surg. 2021;31(4):1656–63. https://doi.org/10.1007/s11695-020-05174-z.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Dr. Irene Baudracco for English revisions.

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Author notes

  1. Maria Vittoria Bertoni and Michele Marengo contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Lugano Regional Hospital, via Tesserete 46, 6900, Lugano, Switzerland

    Maria Vittoria Bertoni, Fabio Garofalo, Francesco Volontè & Francesco Mongelli

  2. Department of Surgery, Bellinzona e Valli Regional Hospital, via Ospedale 10, 6500, Bellinzona, Switzerland

    Michele Marengo & Davide La Regina

  3. Department of Surgery, Sant’Anna Clinic, Via Sant’Anna 1, 6924, Lugano, Switzerland

    Francesco Volontè

  4. Department of Surgery, Cantonal Hospital of Lucerne, Spitalstrasse , 6000, Lucerne , Switzerland

    Markus Gass

  5. Department of Health Sciences and Medicine, University of Lucerne, 6000, Lucerne, Switzerland

    Markus Gass

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  1. Maria Vittoria Bertoni
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Correspondence to Francesco Mongelli.

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Key Points

- Whether robotic surgery is advantageous in revisional bariatric surgery is debatable.

- This study showed no benefit of robotic revisional bariatric surgery.

- High-quality studies investigating the robotic revisional bariatric surgery are needed.

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Bertoni, M.V., Marengo, M., Garofalo, F. et al. Robotic-Assisted Versus Laparoscopic Revisional Bariatric Surgery: a Systematic Review and Meta-analysis on Perioperative Outcomes. OBES SURG 31, 5022–5033 (2021). https://doi.org/10.1007/s11695-021-05668-4

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