Operative Time and 30-Day Outcomes in Bariatric Surgery: Comparison between Robotic and Laparoscopic Approach: 4-Year MBSAQIP Database Analysis

Abstract

BACKGROUND: The main criticism of robotic surgery is longer operative time (OT). The aim of this study was to examine the variables that determine OT, the association between OT and 30-day outcomes, and the effect of the robotic approach in bariatric surgery. STUDY DESIGN: MBSAQIP data for 2016 to 2019 were queried. Logistic regression was performed to examine the association between OT and outcomes for each surgical approach while adjusting for patients’ characteristics. The results of each fitted logistic regression model were reported as odds ratio and the associated 95% CI. RESULTS: A total of 666,182 patients underwent robotic sleeve gastrectomy (R-SG), laparoscopic sleeve gastrectomy, robotic Roux-en-Y gastric bypass (R-RYGB), laparoscopic Roux-en-Y gastric bypass, robotic duodenal switch (R-DS), and laparoscopic duodenal switch). More patients underwent laparoscopic surgery (89.7%) than robotic surgery (10.3%). OT for robotic cases was longer than for laparoscopic cases (p < 0.0001). Longer OT was associated with increased odds of adverse 30-day outcomes irrespective of the surgical approach. The association between OT and adverse outcomes was stronger in the laparoscopic cohort. There was no significant difference in postoperative outcomes when comparing the laparoscopic and robotic approaches after adjusting for OT, except a lower reoperation rate for R-SG (p = 0.03) and readmission rates in R-RYGB and R-DS (p < 0.01). The variability of OT was higher in the laparoscopic group and was more affected by the first assistant. CONCLUSIONS: The outcomes in robotic bariatric surgery were comparable with the laparoscopic approach despite longer OT. Use of robotic surgery decreased the variability in OT.

Updates in Bariatric Surgery

“…66 Despite a longer operative time, studies have shown no significant difference in outcomes between robotic and laparoscopic approaches for bariatric surgery. 67 Even though a robotic approach does not necessarily improve outcomes, there are benefits that are harder to quantify such as improved visualization, improved instrument degrees of freedom, surgeon comfort, and ability to perform the procedure without a skilled surgical assistant. Studies comparing a robotic to a laparoscopic approach are often difficult due to implicit differences and large sample size required to obtain enough power for statistical significance.…”

A new approach for achieving successful introduction of robotic sleeve gastrectomy

“…3,4 Recently, RSG has been performed more frequently than Roux-en-Y gastric bypass in robotic bariatric surgery. 5 In Japan, laparoscopic sleeve gastrectomy (LSG) has been approved by the public health insurance system and is being increasingly performed, 6,7 while RSG has not yet been approved. We perform LSG using the "stapling-rst" technique (SF technique) in which the greater curvature is devascularized after stapling.…”