Comparison of robotic revisional weight loss surgery and laparoscopic revisional weight loss surgery using the MBSAQIP database.

Clapp, Benjamin; Jones, Robin L.; Tyroch, Alan; Dodoo, Christopher; Liggett, Evan

doi:10.1016/j.soard.2018.09.073

Cited by 3 publications

(8 citation statements)

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“…We also used the Xi System. With a mean surgical time of 126 min (rRRYGB), we were well below previous publications (range 167-352 min; Table 3) including MBSAQIP evaluations [28,29]. The docking time of 5 min no longer plays a significant role with corresponding experience using the system.…”

Section: Prossupporting

confidence: 55%

“…A reduction in the LOS was found in one study using the robot [27], while the registry data showed an extended LOS [28]. In the study by Clapp et al [28], the clear differences between cohorts regarding index operation and procedure must be mentioned. Our data show a significant reduction in LOS with rRRYGB.…”

Section: Prosmentioning

confidence: 94%

“…Previous studies mostly reported extended operative times when using the robot [26,28,29], up to 6 h in one study [26]. It has been argued that the results differ only in operative time and LOS in comparable cohorts, and that no benefit is apparent [28]. However, there was a significantly higher proportion of technical simple gastric band removals in the laparoscopic revision group, while consecutively the relative share of complex RYGB operations was higher in the robot group.…”

Section: Prosmentioning

confidence: 95%

“…By using the da Vinci Xi System, we achieve significantly shorter operative times compared to rLRYGB surgery. Previous studies mostly reported extended operative times when using the robot [26,28,29], up to 6 h in one study [26]. It has been argued that the results differ only in operative time and LOS in comparable cohorts, and that no benefit is apparent [28].…”

Section: Prosmentioning

confidence: 99%

“…Another group found a comparable safety profile of robotic interventions, while robotic revisional surgeries after stapled procedures were performed more quickly than laparoscopic ones [27]. Evaluation of registry databases showed no advantages when using the robot [28]. In particular revisional robotic SG (rRSG) showed worse results than rLSG [29].…”

Section: Introductionmentioning

confidence: 99%

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Pros and Cons of Robotic Revisional Bariatric Surgery

Beckmann¹,

Mehdorn²,

Kersebaum³

et al. 2020

Visc Med

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Introduction: Revisional procedures in bariatric surgery are regarded as technically more demanding and riskier than primary interventions. While the use of the surgical robot has not yet proven to be advantageous in primary bariatric interventions, the question remains whether its use is justified for more complex revisional procedures. Objective: To show that revisional bariatric surgery can be performed safely using the da Vinci® Xi surgical system. Methods: We performed a retrospective analysis of prospectively recorded data for revisional bariatric procedures between January 2016 and November 2019. Results: Of 78 revision operations, four (5.1%) were performed by open surgery, 30 (38.5%) by laparoscopic surgery, and 44 (56.4%) by robotic surgery. A comparative analysis of robotic (n = 41) versus laparoscopic (n = 18) revisional Roux-en-Y gastric bypasses (rRYGB) revealed significant differences favoring the robotic approach for operative time (130.7 vs. 167.6 min), C-reactive protein values at days 1 (27.9 vs. 49.1 mg/L) and 2 (48.2 vs. 83.6 mg/L) after surgery, and length of stay (4.9 vs. 6.2 days). Lower complication rates (Clavien-Dindo II–V) were found after rRRYGB (7.3 vs. 22.2%, not significant). Conclusions: Revisional bariatric surgery using a robotic system is safe. The operative time performing rRRYGB is significantly shorter than rLRYGB in our experience. Otherwise, results were largely comparable. Due to different indications, different index operations and a wide range of revisional procedures, further studies are necessary to confirm these results.

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Section: Prossupporting

confidence: 55%

Section: Prosmentioning

confidence: 94%

Section: Prosmentioning

confidence: 95%

Section: Prosmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Pros and Cons of Robotic Revisional Bariatric Surgery

Beckmann¹,

Mehdorn²,

Kersebaum³

et al. 2020

Visc Med

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Outcomes of primary versus revisional robotically assisted laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of ten-year experience

et al. 2020

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Background Postoperative morbidity after laparoscopic bariatric surgery is considered higher for patients undergoing revisional versus primary procedures. The objective of this retrospective cohort study was to compare outcomes between patients undergoing primary versus revisional robotically assisted laparoscopic (RAL) Roux-en-Y gastric bypass (RYGB). Methods Data of all patients who underwent RAL primary and revisional RYGB between 2009 and 2019 at two accredited, high-volume bariatric surgery centers—the Memorial Hermann – Texas Medical Center, Houston, TX, and the Tower Health, Reading Hospital, Reading, PA, were analyzed. Primary outcomes were early (< 30 days) and overall postoperative complications. Secondary outcomes included intraoperative complications, operative times, conversions to laparotomy, length of hospital stay, early (< 30 days) postoperative readmissions and deaths. Results Data of 1072 patients were analyzed, including 806 primary and 266 revisional RAL RYGB procedures. Longer operative times (203 versus 154 min, P < 0.001), increased number of readmissions for oral intolerance (10.5% versus 6.7%, P = 0.046) and higher rate of gastrojejunal stricture (6.4% versus 2.7%, P = 0.013) were found in the revisional group. Gastrointestinal leak rates were 0.2% for the primary versus 1.1% for the revisional group (P = 0.101). Early (< 30 days) reoperations rates were 2.2% for the primary versus 1.1% for the revisional group (P = 0.318). There were no statistically significant differences between groups in overall and severe complication rates. Conclusion Patients undergoing RAL primary and revisional RYGB had comparable overall outcomes, with a non-significant higher early complication rate in the revisional group. Despite the study being underpowered to detect differences in specific complication rates, the morbidity seen in the revisional RYGB group remains markedly below literature reports of revisional laparoscopic RYGB and might suggest a benefit of robotic assistance. Further prospective studies are needed to confirm these results.

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Assessment of predictors of early postoperative complications after primary robotically assisted Roux-en-Y gastric bypass: a multicenter, retrospective cohort study

et al. 2022

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Background Robotic Roux-en-Y gastric bypass (RRYGB) is performed in an increasing number of bariatric centers worldwide. Previous studies have identified a number of demographic and clinical variables as predictors of postoperative complications after laparoscopic Roux-en-Y gastric bypass (LRYGB). Some authors have suggested better early postoperative outcomes after RRYGB compared to LRYGB. The objective of the present study was to assess potential predictors of early postoperative complications after RRYGB. Methods A retrospective analysis of two prospective databases containing patients who underwent RRYGB between 2006 and 2019 at two high volumes, accredited bariatric centers was performed. Primary outcome was rate of 30 day postoperative complications. Relevant demographic, clinical and biological variables were entered in a multivariate, logistic regression analysis to identify potential predictors. Results Data of 1276 patients were analyzed, including 958 female and 318 male patients. Rates of overall and severe 30 day complications were 12.5% (160/1276) and 3.9% (50/1276), respectively. Rate of 30 day reoperations was 1.6% (21/1276). The overall gastrointestinal leak rate was 0.2% (3/1276). Among various demographic, clinical and biological variables, male sex and ASA score >2 were significantly correlated with an increased risk of 30 day complication rates on multivariate analysis (OR 1.68 and 1.67, p=0.005 and 0.005, respectively). Conclusion This study identified male sex and ASA score >2 as independent predictors of early postoperative complications after RRYGB. These data suggest a potentially different risk profile in terms of early postoperative complications after RRYGB compared to LYRGB. The robotic approach might have a benefit for patients traditionally considered to be at higher risk of complications after LRYGB, such as those with BMI >50. The present study was however not designed to assess this hypothesis and larger, prospective studies are necessary to confirm these results.

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Comparison of robotic revisional weight loss surgery and laparoscopic revisional weight loss surgery using the MBSAQIP database.

Cited by 3 publications

References 0 publications

Pros and Cons of Robotic Revisional Bariatric Surgery

Pros and Cons of Robotic Revisional Bariatric Surgery

Outcomes of primary versus revisional robotically assisted laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of ten-year experience

Assessment of predictors of early postoperative complications after primary robotically assisted Roux-en-Y gastric bypass: a multicenter, retrospective cohort study

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