Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass

Abstract

Background Traditional laparoscopic surgery presents some difficulties for morbidly obese patients due to limited motion of instruments related to a thick abdominal wall, intraabdominal fat, and a large hepatic left lobe, with consequent loss of dexterity and greater musculoskeletal discomfort. Robotic technique could potentially overcome these limitations. This study aimed to evaluate robot-assisted laparoscopic Roux-en-Y gastric bypass in morbidly obese patients and to compare the results of robotic assistance with those of traditional laparoscopic technique. Methods Between September 2006 and June 2009, 110 morbidly obese patients underwent laparoscopic Roux-en-Y gastric bypass with robot-assisted hand-sewn gastrojejunal anastomosis using the da Vinci Surgical System. The data for these patients was compared with the data for 423 consecutive patients treated in a standard laparoscopic manner during the same period. Results The patients had a mean preoperative age of 42.6 years, a mean weight of 127.5 kg, and a mean body mass index (BMI) of 46.7 kg/m 2 . The total mean operative time was 247.5 min. The robotic setup time was 10.1 min, and the robotic operative time was 54.5 min. The conversion rate was nil. The intraoperative complication rate was 4.5%. The early and late major postoperative complication rates were 3.6 and 6.4% respectively. The cost per patient was 5777.76 €. For the standard laparoscopy, the operative time was significantly shorter (187 min; p < 0.001), and the costs per patient were significantly lower (4658.28 €; p < 0.001), whereas no differences were found in terms of the intra-or postoperative complication rates, revisional surgery, or hospital length of stay. Conclusions Although safe and intuitive, the robotic approach was burdened by a longer operative time and higher equipment costs. Moreover, it did not seem to provide a real advantage over standard laparoscopy in terms of hospital length of stay and complications rates. Keywords Bariatric surgery Gastrojejunal anastomosis Morbid obesity Robot-assisted gastric bypass Robotic surgery Roux-en-Y gastric bypass To date, bariatric surgery is the only long-term effective therapy available for the morbidly obese population [1][2][3]. Over recent decades, laparoscopic surgical techniques have become the gold standard in bariatric surgery due to advantages such as less postoperative pain, shorter hospital stay, faster postoperative recovery, and minimal scarring [4][5][6]. Moreover, for the obese patient, the mini-invasive approach has demonstrated its ability to reduce postoperative mortality [7,8]. However, the inherent limitations of traditional laparoscopic surgery may cause some technical difficulties due to the limited freedom of motion for the instruments related to the thick abdominal wall and hepatomegaly, with consequent loss of dexterity and greater musculoskeletal discomfort for the surgeon [9].

Robot-assisted total gastrectomy is comparable with laparoscopically assisted total gastrectomy for early gastric cancer

“…Recent studies have demonstrated that the robotic approach does not provide an advantage over laparoscopy [10][11][12][13]. Even 20 of the initial robot-assisted gastrectomies had results similar to those for experienced laparoscopically assisted gastrectomies in one report [14].…”

SAGES TAVAC safety and effectiveness analysis: da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, CA)

“…A single randomized trial exists showing equivalent outcomes [57]. Other large trials include case control studies with up to 400 patients per group or case series (one including over 1000 robotic RYGB) [58][59][60][61][62][63][64][65][66][67][68][69]: These studies all confirm non-inferiority of the robotic approach, and most demonstrate some benefit when compared with laparoscopy in reduction in gastrojejunal (GJ) leak rates, reduced strictures rates, or reduced length of stay. Data also consistently show longer operative times in the robotic groups.…”

Robotic and laparoscopic gastric bypass: are they comparable?

“…The study by Scozzari et al [1] tried to assess the value of the robotic procedure by comparing a cohort of 110 consecutive robotassisted gastric bypasses with 423 consecutive laparoscopic RYGBPs performed at two different centers over a period of 3 years. They concluded that even though robot assistance achieves the same short-term outcomes with respect to weight loss, postoperative morbidity and length of hospital stay, the robotic approach is diminished by longer operative time and higher hospital costs.…”

“…We read with interest the article by Scozzari et al [1], which reports the results of a retrospective comparison between laparoscopic and robot-assisted gastric bypass. During the last 5 years the increased interest in robotic surgery did not spare the field of bariatric surgery, and several comparative studies between laparoscopic and robotic or robot-assisted Roux en-Y gastric bypass (RYGBP) have been carried out, searching for potential improvements in the outcomes of standard laparoscopic RYGBP [2][3][4][5][6].…”