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Robotic versus laparoscopic Roux-en-Y gastric bypass (RYGB) in obese adults ages 18 to 65 years: a systematic review and economic analysis

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Abstract

Background

In the United States, 37.5 % of adults (78 million) are obese. The direct medical costs of treating obesity-related disease account for more than 6 % of the national health expenditure. Robotic bariatric surgery is becoming more common, but it is unclear whether robotic procedures result in lower complication rates. Additionally, some evidence is conflicting regarding the costs of robotic Roux-en-Y gastric bypass (RYGB) compared with those of laparoscopic RYGB. This study aimed to compare complication rates, operative characteristics, and expected costs between robotic and laparoscopic RYGB.

Methods

A systematic review of the literature was performed with searches of five databases and grey literature, hand searches, and reference and forward citation searches. Studies comparing robotic versus laparoscopic RYGB involving patients ages 18–65 years who met the National Institutes of Health (NIH) criteria for bariatric surgery were included in the study if they reported overall or major complication rates. Outcomes were pooled using random-effects metaanalysis. A decision-tree economic analysis was performed to calculate expected costs associated with each technique.

Results

The systematic search strategy returned 1,374 potentially relevant studies. The inclusion criteria were met by 10 of these studies, which included results from 2,557 patients. The overall major and minor complications did not differ significantly between the robotic and laparoscopic groups. The rates for anastomotic leak, bleeding, stricture, and reoperation did not differ significantly. An economic analysis found that the expected costs for robotic RYGB ($15,447) were higher than for laparoscopic RYGB ($11,956). Sensitivity analyses produced similar results.

Conclusion

The complication rates did not differ significantly between robotic and laparoscopic RYGB, but the expected costs were greater for robotic RYGB. Further cost effectiveness analyses are recommended before adoption of a robotic approach to RYGB.

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Disclosures

James Ellsmere is a consultant for Ethicon Endo-Surgery Inc. Jonathan G. Bailey, Jill A. Hayden, Philip J. B. Davis, Richard Y. Liu, and David Haardt, have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of General Surgery, QEII Health Sciences Centre, Dalhousie University, 8819 Victoria Building, 1276 South Park St, V.G. Site, Halifax, NS, B3H 2Y9, Canada

    Jonathan G. Bailey, Philip J. B. Davis, Richard Y. Liu & James Ellsmere

  2. Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada

    Jill A. Hayden

  3. School of Health Administration, Dalhousie University, Halifax, NS, Canada

    David Haardt

Authors
  1. Jonathan G. Bailey
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  2. Jill A. Hayden
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  3. Philip J. B. Davis
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  4. Richard Y. Liu
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  6. James Ellsmere
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Corresponding author

Correspondence to Jonathan G. Bailey.

Appendices

Appendix 1: Search strategy for PubMed (adapted for other database searches)

  • 1. Obesity OR Weight Loss OR Overweight

  • 2. Obes* OR overweight OR over*weight OR over weight OR overeating OR over*eating OR weight loss OR Weight reduc*

  • 3. Bariatric Surgery OR Gastric Bypass OR gastroenterostomy OR gastroplasty OR obesity/su OR Obesity, Morbid/surgery OR Anastomosis, Surgical

  • 4. Bariatric surg* OR anti obesity surg* OR antiobesity surg* OR obesity surg* OR gastroplasty OR gastrogastrostomy OR gastrostomy OR “gastric surgery” OR “restrictive surgery” OR gastrointestinal surg* OR gastrointestinal diversion* OR gastrectomy OR stomach stapl* OR RYGB OR malabsorptive surg* OR malabsorptive procedure* OR Roux-en-Y OR stomach stapl* OR Gastric bypass

  • 5. Robotics

  • 6. Robot* OR Master*Slave OR Telemanipulators OR Tele surgery OR “Intuitive surgical” OR “Da vinci” OR MONA

  • 7. Laparoscopy OR Surgical OR Procedures, Minimally Invasive

  • 8. Laparoscop* OR Minimally invasive OR LAGB

  • 9. #1 OR #2

  • 10. #3 OR #4 OR #7 OR #8

  • 11. #5 OR #6

  • 12. #9 AND #10 AND #11

  • 13. #9 AND #10 AND #11 Filters: Publication date from 1995/01/01 to 2012/12/31; Humans

Appendix 2. Risk of bias assessment for included studies

Appendix 3. Funnel plots comparing study sample size with odds ratios between robotic and laparoscopic RYGB for major and overall complications

See Figs. 6 and 7.

Fig. 6
figure 6

Funnel plot of comparison. 1 complications, outcomes. 1.1 Over all complication rate

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Fig. 7
figure 7

Funnel plot of comparison. Major complication

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Bailey, J.G., Hayden, J.A., Davis, P.J.B. et al. 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 (2014). https://doi.org/10.1007/s00464-013-3217-8

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