Current Status of Robot-Assisted Revisional Bariatric Surgery

Abstract

Bariatric surgery has been demonstrated to be effective in achieving significant weight loss and remission of obesity-related comorbidities. However, a percentage of patients fail to lose enough weight, regain weight, or experience postoperative complications, requiring additional interventions. Revisional bariatric surgeries (RBS) involve the wide spectrum of procedures that aim to treat complications of the index operation or achieve further weight loss. These are technically challenging procedures due to adhesions of the internal organs, reduced working space, and a distorted anatomy. Indications, timing, and type of operation for RBS are not standardized, and there is no consensus on the best surgical approach. Some authors claim a robotic platform could be advantageous in these types of procedures that are performed in reduced, deep operating fields, or those requiring precision and accuracy. This review examines the most current and representative literature on the outcomes of robot-assisted RBS. Included studies demonstrate the safety and feasibility of the robotic approach for RBS. However, long operative times and high costs remain major drawbacks of the device. Finally, if we consider that many centers have not yet completed the learning curve for robot-assisted RBS, the potential for improved outcomes seems promising.

The Trajectory of Revisional Bariatric Surgery: Open to Laparoscopic to Robotic

“…Operative time depends on the surgical skillset and learning curve and is also related to the procedure and its associated complications, as well as the clinical condition of the patient population. It is important to note that the learning curve is not solely concerning the technical skills of the surgeon but also involves the knowledge, expertise and ability of the surgical staff in proper setup, docking and instrument handling [95,99]. As with every new technique and technology, it is natural for a surgical team to need time to become fully acquainted.…”

SADI-S vs OAGB como cirugía revisional después de gastrectomía vertical. Revisión sistemática

“…Considerando lo anteriormente enunciado, existen estudios con seguimientos de 3 -5 años en donde se observan índices de conversión de GV hasta un 36% a 10 años. [1,3,7,10,[16][17][18]…”

“…En cirugías revisionales se ha observado hasta el doble del tiempo operatorio y estancia hospitalaria acompañado de mayor cantidad de complicaciones como sangrado, deserosamientos, y fallo de sutura, donde se alcanzan índices de morbilidad del 41% en PR vrs 15% en procedimientos primarios. [18][19][20][21] Por lo anterior enunciado, es necesario sopesar los beneficios de una segunda intervención sobre los riesgos de la misma, además de maximizar los esfuerzos por reducir complicaciones. Existen principalmente 5 opciones de procedimientos revisionales para el fallo de GV.…”

Robotic versus laparoscopic revisional bariatric surgeries: a systematic review and meta-analysis

“…Over the past decade, the use of robotic platforms for both primary and RBS has been on the rise. Notably, the first instance of a robotic approach for bariatric surgery was demonstrated by Himpens in 1998, who successfully performed a robotic AGB [ 5 ].…”

“…The promise of the robot in RBS seems significant as this technology has already exhibited perioperative outcomes comparable to traditional laparoscopy [ 5 ]. Our objective in this meta-analysis is to juxtapose the perioperative outcomes of robotic and conventional laparoscopic techniques solely in RBS.…”