Robotically assisted revision of bariatric surgeries is safe and effective to achieve further weight loss

Robotic bariatric surgery reduces morbidity for revisional gastric bypass when compared to laparoscopic: outcome of 8-year MBSAQIP analysis of over 40,000 cases

INTRODUCTION

Robotic-assisted metabolic and bariatric surgery (MBS) is gaining popularity. Revisional MBS is associated with higher perioperative morbidity compared to primary MBS. The optimal surgical approach to minimize complications in these complex cases is unclear. The goal of this study was to assess robot utilization in revisional MBS and compare laparoscopic and robotic revisional MBS outcomes in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.

METHODS

A retrospective review of the MBSAQIP database was performed identifying revisional sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) cases from 2015 to 2022. Primary MBS, open/emergent cases, cases converted to another approach, and combined cases other than esophagogastroduodenoscopy were excluded. 30-Day outcomes for laparoscopic and robotic cases were compared using multivariate logistic regression adjusting for patient demographics, comorbidities, and operative variables.

RESULTS

41,404 Cases (14,474 SG; 26,930 RYGB) were identified. From 2015 to 2022, the percentage of revisional SG and RYGB cases performed robotically increased from 6.1% and 7.3% to 24.2% and 32.0% respectively. Laparoscopic SG had similar rates of overall morbidity, leak, bleeding, readmission, reoperation, and length of stay compared to robotic. Laparoscopic RYGB had significantly higher rates of overall morbidity (6.2% vs. 4.8%, p < 0.001, AOR 0.80 [0.70-0.93]), blood transfusion (1.5% vs. 1.0%, p < 0.05, AOR 0.74 [0.55-0.99]), superficial incisional SSI (1.2% vs. 0.4%, p < 0.001, AOR 0.30 [0.19-0.47]), and longer length of stay (1.87 vs. 1.76 days, p < 0.001) compared to robotic. Laparoscopic operative times were significantly shorter than robotic (SG: 86.4 ± 45.8 vs. 113.5 ± 51.7 min; RYGB: 130.7 ± 64.7 vs. 165.5 ± 66.8 min, p < 0.001).

CONCLUSION

Robot utilization in revisional bariatric surgery is increasing. Robotic surgery has lower postoperative morbidity and shorter length of stay in revisional RYGB when compared to laparoscopic. Robotic platforms may have the capacity to improve the delivery of care for patients undergoing revisional bariatric surgery.

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

Metabolic and bariatric surgery (MBS) is the most effective therapeutic intervention for patients with obesity, with sleeve gastrectomy (SG) being the most commonly performed primary MBS procedure. Long-term studies have demonstrated that 15-20% of patients require revisional bariatric surgery (RBS) due to weight-related issues or surgical complications. Despite the gold standard being laparoscopic revision, there are other available approaches such as open or robotic-assisted. An extensive literature review was performed for articles from their inception to February 2024. A descriptive review of MBS procedures (SG, Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileostomy (SADI) and biliopancreatic diversion-duodenal switch (BPD-DS)) was carried out to report and compare outcomes between primary and revisional bariatric surgery. A similar review was conducted to compare outcomes of revisional approaches (open, laparoscopic, robotic). RYGB remains the dominant RBS with a similar safety profile compared to revisional SADI and BPD-DS. In terms of the RBS surgical approach, all three options showed comparable short and long-term outcomes, with robotic RBS being associated with longer operative time and variable length of stay. Additional long-term studies are required to further validate our conclusions.

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

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.

Current Status of Robot-Assisted Revisional Bariatric Surgery

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.

Outcomes of Bariatric Surgery: Patients with Body Mass Index 60 or Greater

Introduction:

Perioperative outcomes of bariatric surgery in patients with super super obesity (SSO) (BMI ≥ 60 kg/m²) merit further investigation.

Methods:

A retrospective review was conducted of patients with SSO who underwent surgery from Jun 2005 through Jun 2018 at a Metabolic and Bariatric Surgery Center of Excellence. Quantitative demographic data was summarized using descriptive statistics; categorical variables were compared using Fisher’s exact test.

Results:

Two hundred fourteen procedures were performed, of which 208 were eligible for inclusion. Majority were female (65.4%). The mean age and BMI was 43 (17–68 years) and 65.9 kg/m² (60 95 kg/m²), respectively. Comorbidities included: obstructive sleep apnea (74%), hypertension (59%), gastro-esophageal reflux disease (43%), osteoarthritis (41%), and diabetes mellitus (30%). Surgical approach: 97 Roux-en-Y gastric bypasses (46%), 88 laparoscopic sleeve gastrectomies (42%), and 23 adjustable gastric bands (11%). Additional subset included: primary (87%), conversion (7.7%), and revision (5.3%); majority being laparoscopic (75%) and robotic (24%). Complications via Clavien-Dindo classification: one Grade I, one Grade II, three Grade IIIa, three Grade IIIb, and three Grade IVa. Thirty-day events: 11 complications (5.3%; one leak [0.5%], one deep vein thrombosis [0.5%]), six re-admissions (3%), four re-operations (2%): repair of staple-line leak, repair of incisional hernia, uterine dilation and curettage, and cholecystectomy. No mortalities occurred. Complications occurred in 14.8% of conversion/revision cases, 3.9% in primary cases (p = 0.0395) with no difference observed between laparoscopic (4.5%) and robotic (6.1%) modalities (p = 0.7051).

Conclusion:

Bariatric surgery is feasible in patients with SSO. Revision procedures may increase risk of operative complications.

Robotic Revisional Bariatric Surgery: a High-Volume Center Experience

PURPOSE

The number of bariatric revisional procedures is growing. Scarce evidence is available regarding the role and postoperative outcomes of robotic-assisted revisional bariatric surgery (RRBS). The aim of this study is to evaluate the safety and postoperative outcomes of RRBS.

MATERIALS AND METHODS

A retrospective analysis of a prospectively collected database of patients who underwent RRBS between 2012 and 2019 was performed. Primary outcomes of interest were 30-day major morbidity, mortality, length of hospital stay (LOS), urgent reoperation rates, and percentage of total weight loss (%TWL).

RESULTS

RRBS was performed in 76 patients; among these 60 (78.9%) underwent conversion to Roux-en-Y gastric bypass (C-RYGB). Failed weight loss (76%) and gastroesophageal reflux (9.2%) were the main indications for revision. Primary bariatric procedures included gastric band (LAGB) (50%), sleeve gastrectomy (SG) (40.8%), and RYGB (6.6%). Major morbidity and mortality rates were 3.9% and 1.3%, respectively. Mean LOS was 2.1 days, and 3 patients (3.9%) required urgent reoperation. The %TWL at 3, 6, 12, and 24 months was 10.2%, 16.6%, 18.3%, and 22.4% respectively. Comparative analysis of C-RYGB after failed LAGB and SG showed similar morbidity. Higher readmission rates (SG: 22.2% vs. LAGB: 0%, p = 0.007) and lower %EWL at 3, 6, 12, and 24 months were found in C-RYGB after SG.

CONCLUSION

This is one of the largest single-center series of RRBS published in the literature; the data indicate that robotic approach for revisional bariatric surgery is safe and helps achieving further weight loss. RRBS outcomes might be influenced by the primary procedure.

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

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.

Pros and Cons of Robotic Revisional Bariatric Surgery

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.

Feasibility and safety of robot-assisted bariatric conversions and revisions

BACKGROUND

Conversions and revisions after bariatric procedures are inevitable and associated with longer operative time and higher complication rates. Because robot-assisted procedures allow better dissection, robotic conversions and revisions may be more beneficial to the patients than laparoscopic ones.

OBJECTIVES

This study aimed to compare the feasibility and safety of robot-assisted conversions and revisions to laparoscopic procedures.

SETTING

Academic Hospital, United States.

METHODS

A retrospective chart review was performed on 94 consecutive patients who underwent a bariatric conversion or revision (revision of gastrojejunostomy, conversions of vertical sleeve gastrectomy to Roux-en-Y gastric bypass, adjustable gastric banding to sleeve gastrectomy, Roux-en-Y gastric bypass to sleeve gastrectomy, adjustable gastric banding to Roux-en-Y gastric bypass, Roux-en-Y gastric bypass to duodenal switch, and adjustable gastric banding to duodenal switch) between January 1, 2017, and February 28, 2019. Of these, 30 underwent a robot-assisted conversion or revision.

RESULTS

Patients who underwent a robot-assisted approach were more likely to be older (45.4-versus 38.8-yr old) and lighter (44.6 versus 50.3 kg/m²) than patients who underwent a laparoscopic approach. The mean operative time was longer in the robot-assisted group (155.5 min) than in the laparoscopic group (113.3 min). No difference was observed between the 2 groups in the mean length of hospital stay, 30-day readmission rate, or 30-day reoperation rate. Results were similar when the baseline difference in age and body mass index were accounted for.

CONCLUSIONS

Robot-assisted conversions and revisions were as feasible and safe as laparoscopic procedures. However, operative time was longer in robot-assisted conversions.

Comparative analysis of robotic versus laparoscopic revisional bariatric surgery: perioperative outcomes from the MBSAQIP database

BACKGROUND

There are limited data evaluating the role of robotics in revisional bariatric surgery (RBS) compared with laparoscopy.

OBJECTIVE

The purpose of this study was to compare perioperative outcomes of laparoscopic and robotic RBS.

SETTING

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.

METHODS

The 2015 to 2017 MBSAQIP database was queried for patients undergoing revisional robotic and laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Multivariate logistic regression was used to compare outcomes between robotic and laparoscopic approaches, adjusting for demographic characteristics, co-morbidities, and operative time.

RESULTS

A total of 17,012 patients underwent revisional SG with 15,935 (93.7%) laparoscopic and 1077 (6.3%) robotic, and 12,442 patients underwent revisional RYGB with 11,212 (90.1%) laparoscopic and 1230 (9.9%) robotic. Overall morbidity was higher in robotic SG compared with laparoscopic SG (6.7% versus 4.5%; adjusted odds ratio 1.51; P < .01) which was not the case after adjustment for operative time. Robotic RYGB was associated with comparable overall morbidity to laparoscopic (9.3% versus 11.6%; adjusted odds ratio .83; P = .07) although respiratory complications, pneumonia, superficial surgical site infections, and postoperative bleeding were lower with robotic RYGB. The robotic approach with both procedures was associated with longer operative time (P < .01). Length of stay was longer in the robotic group for SG (P < .01) but was not different for RYGB (P = .91).

CONCLUSIONS

Robotic RBS has an increased complication profile compared with the laparoscopic approach for SG and decreased for RYGB. Further analysis is needed regarding variability in surgeon technique and operative experience to determine what factors contribute to these differences.

Value of robotic-assisted technique in redo gastrojejunostomy for severe stenosis after gastric bypass

Development of gastrojejunal stricture following Roux-en-Y gastric bypass (RYGB) leads to an increase in morbidity and adverse effects, such as abdominal pain, vomiting, aspiration pneumonia, and malnutrition. Up to 38.5% of patients will require revisional surgery for late anastomotic strictures despite conservative treatment. However, no previous studies focused on revisional robotic bariatric surgery due to strictures after RYGB have been reported. To evaluate our outcomes and assess the advantages of the robotic platform with regard to laparoscopic and open revisional procedures. University Hospital. We performed a retrospective analysis of patients who underwent laparoscopic robotic-assisted redo gastrojejunostomy from 2016 to 2018. Demographics, surgical data, medical treatments, postoperative outcomes, and adverse effects were collected. Nine patients with symptomatic anastomotic strictures after primary RYGB underwent robotic revisional surgery. All patients received medical therapy as a first approach, and five patients (55.5%) underwent endoscopic balloon dilation. All procedures were successfully completed with robotic assistance, with a mean (standard deviation) operative time of 184.5 (49.1) min, and no intraoperative adverse effects were registered. Median (range) hospital stay was 2 (1-4) days. One patient presented with a postoperative intra-abdominal abscess and was treated with intravenous antibiotics and image-guided drainage. No anastomotic leak, hemorrhage, or mortality were reported. Robotic assistance seems to be safe and effective for redo gastrojejunostomy secondary to stricture. Even though the sample size is small, we believe that the application of robotic techniques may provide advantages and improve the outcomes in these complex revisional procedures.

Outcomes in conventional laparoscopic versus robotic-assisted revisional bariatric surgery: a retrospective, case-controlled study of the MBSAQIP database

Introduction

Revisional bariatric surgery is being increasingly performed and is associated with higher operative risks. Optimal techniques to minimize complications remain controversial. Here, we report a retrospective review of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant User Files (PUF) database, comparing outcomes between revision RBS and LBS.

Methods

The 2015 and 2016 MBSAQIP PUF database was retrospectively reviewed. Revision cases were identified using the Revision/Conversion Flag. Selected cases were further stratified by surgical approach. Subgroup analysis of sleeve gastrectomy and gastric bypass cases was performed. Case–controlled matching (1:1) was performed of the RBS and LBS cohorts, including gastric bypass and sleeve gastrectomy cohorts separately. Cases and controls were match by demographics, ASA classification, and preoperative comorbidities.

Results

26,404 revision cases were identified (93.3% LBS, 6.7% RBS). 85.6% were female and 67% white. Mean age and BMI were 48 years and 40.9 kg/m². 1144 matched RBS and LBS cases were identified. RBS was associated with longer operative duration (p < 0.0001), LOS (p = 0.0002) and a higher rate of ICU admissions (1.3% vs 0.5%, p = 0.05). Aggregate bleeding and leak rates were higher in the RBS cohort. In both gastric bypass and sleeve gastrectomy cohorts, the robotic-assisted surgery remain associated with longer operative duration (p < 0.0001). In gastric bypass, rates of aggregate leak and bleeding were higher with robotic surgery, while transfusion was higher with laparoscopy. For sleeve gastrectomy cases, reoperation, readmission, intervention, sepsis, organ space SSI, and transfusion were higher with robotic surgery.

Conclusion

In this matched cohort analysis of revision bariatric surgery, both approaches were overall safe. RBS was associated with longer operative duration and higher rates of some complications. Complications were higher in the robotic sleeve cohort. Robotic is likely less cost-effective with no clear patient safety benefit, particularly for sleeve gastrectomy cases.

Outcomes of Robot-Assisted Roux-en-Y Gastric Bypass as a Reoperative Bariatric Procedure

BACKGROUND

We evaluate the outcomes of robot-assisted Roux-en-Y gastric bypass (RRYGB) as a reoperative bariatric procedure (RBP).

METHODS

A retrospective analysis was done from 2007 to 2014, and all the patients who underwent RRYGB as a RBP at a teaching university hospital were included.

RESULTS

A total of 32 patients underwent RRYGB as a reoperation from adjustable gastric band (AGB n = 16) or sleeve gastrectomy (SG n = 11) or previous gastric bypass (n = 5). Twenty patients underwent conversion to RRYGB due to weight loss failure, either after AGB (n = 13) or SG (n = 7). Twelve patients underwent reoperation because of complications of index procedure. Mean preoperative weight was 109.7 ± 29.5 kg, and BMI was 40 ± 10.6 kg/m(2). The mean operative time for RRYGB was 226 ± 45.3 min with a blood loss of 20 ± 15.9 ml. Average length of stay was 3 days. In two cases, pin point leaks were detected intraoperatively during check gastroscopy, and they were repaired with sutures. There were no postoperative anastomotic leaks or hemorrhage or gastrojejunostomy strictures. None of the patients required a blood transfusion or reoperation within perioperative period. In the patients who underwent RRYGB for weight loss failure (n = 20), the mean excess weight loss (EWL) was 39.2% at 6 months (n = 11), 53.8% at 1 year (n = 13), and 60.7% at 2 years (n = 6).

CONCLUSIONS

RRYGB is safe and effective to be used as a revisional bariatric procedure. The weight loss outcomes and complication rates compare favorably with the published results of laparoscopic technique, although the small sample size may not be enough to reach definite conclusions.

A review of the role of robotics in bariatric surgery

The epidemic of obesity continues to be a major health issue. It is now almost uniform that surgical procedures for weight loss are performed with minimally invasive techniques. This article reviews the literature regarding obesity-related health issues, in particular risk of malignancy, and the application of robotic technology in weight loss surgical procedures. With increasing literature and technology in surgical robotics, its application in the field of bariatric surgery continues to evolve.

The evolution of robotic bariatric surgery

INTRODUCTION

The growth of bariatric surgery has resulted in varying types of procedures with increasing complexity. Robotic digital platforms are employed in bariatric surgery to address this increasing complexity in the high-risk obese patient population with difficult anatomy.

MATERIALS AND METHODS

This review explores the literature and examines the reported outcomes and complications in using robotics for bariatric surgery. Robotic approaches to adjustable gastric banding, sleeve gastrectomy, gastric bypass, and biliopancreatic diversion with duodenal switch are examined. Revisional cases, learning curves, and cost effectiveness are reviewed, with an eye toward the future of bariatric surgery as the use of robotics is adopted.

CONCLUSION

Digital platforms are showing great promise as enabling technology which advance bariatric outcomes. With increasingly complex bariatric cases being performed and revised, the insertion of digital information between the surgeon and the patient leads to better operations for the patient and the surgeon.

Review of contemporary role of robotics in bariatric surgery

With the rise in a number of bariatric procedures, surgeons are facing more complex and technically demanding surgical situations. Robotic digital platforms potentially provide a solution to better address these challenges. This review examines the published literature on the outcomes and complications of bariatric surgery using a robotic platform. Use of robotics to perform adjustable gastric banding, sleeve gastrectomy, roux-en-y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch and revisional bariatric procedures (RBP) is assessed. A search on PubMed was performed for the most relevant articles in robotic bariatric surgery. A total of 23 articles was selected and reviewed in this article. The review showed that the use of robotics led to similar or lower complication rate in bariatric surgery when compared with laparoscopy. Two studies found a significantly lower leak rate for robotic gastric bypass when compared to laparoscopic method. The learning curve for RYGB seems to be shorter for robotic technique. Three studies revealed a significantly shorter operative time, while four studies found a longer operative time for robotic technique of gastric bypass. As for the outcomes of RBP, one study found a lower complication rate in robotic arm versus laparoscopic and open arms. Most authors stated that the use of robotics provides superior visualisation, more degrees of freedom and better ergonomics. The application of robotics in bariatric surgery seems to be a safe and feasible option. Use of robotics may provide specific advantages in some situations, and overcome limitations of laparoscopic surgery. Large and well-designed randomised clinical trials with long follow-up are needed to further define the role of digital platforms in bariatric surgery.

Early outcomes of the first Brazilian experience in totally robotic bariatric surgery

BACKGROUND

Currently, bariatric surgery is the most effective therapy for morbid obesity, and the laparoscopic approach is considered gold-standard for Roux-en-Y gastric bypass. Totally robotic Roux-en-Y gastric bypass has been proposed as a major evolution in minimally invasive bariatric surgery and its use is becoming more widespread.

AIM

To provide an early report of the first Brazilian case-series of totally robotic gastric bypass and perioperative short-term outcomes.

METHODS

All consecutive patients who underwent totally robotic gastric bypass at two recognized centers of bariatric surgery were included. Patient demographic data, body mass index, operative times, hospital stay, complications and mortality in the 30 postoperative days were recorded. The surgeons received the same training program before the clinical procedures and all the surgeries were performed under the supervision of an experienced robotic surgeon.

RESULTS

The surgeries were performed by five surgeons and included 68 patients (52 women - 76.5%), with a mean age of 40.5 years (range 18 to 59) and mean BMI of 41.3 (35.2 - 59.2). Total mean operative time was 158 minutes (range 90 to 230) and mean overall hospital stay was 48 h. Postoperative surgical complication rate (30 day) was 5.9%, with three minor and one major complication. There was no mortality, leak or stricture.

CONCLUSION

Even with surgeons in early learning curves, the robotic approach within a well-structured training model was safe and reproducible for the surgical treatment of the morbid obesity.

Robotic Roux-en-Y gastric bypass: operative results in 100 patients

BACKGROUND

Laparoscopic gastric bypass is gold-standard for morbid obesity treatment.

AIM

To describe the results of robotic gastric bypass for morbid obesity patients.

METHOD

Were operated on 100 morbidly obese patients through totally robotic gastric bypass between 2013 and 2014. They were 83% female. The age ranged from 20 to 65 years old (medium 48,5 years); the body mass index varied between 38-67 (medium 42,3 kg/cm2). The procedure was designed with 3 cm long gastric pouch, 1 m biliopancreatic limb, 1,2 m alimentary limb, manual or stapled anastomosis. There were four super-super-obese patients and four revisional surgeries.

RESULTS

Docking time varied from 1 to 20 min (medium 4 min). Console time varied from 40-185 min (medium 105 min). There were no intra operative complications or mortality. There were two lower limb deep venous thrombosis. There was no readmission in the first 30 days.

CONCLUSION

Totally robotic gastric bypass is safe and reproduceable, with excellent results even during the initial experience with regular surgeries, revisional surgeries or in super-obese patients. Adequate training may shortens or obviates the learning curve.