Australian experience with robot-assisted Roux-en-Y gastric bypass with comparison to a conventional laparoscopic series

Robotic bariatric surgery in Australia: early outcomes from a national clinical quality registry with propensity score matched analysis

The robotic approach to metabolic bariatric surgery (MBS) is becoming more popular despite limited data supporting beneficial outcomes. The objective of this study was to evaluate the early outcomes of robotic MBS in Australia. An observational analysis of prospectively maintained data from the Australian arm of the Australia and New Zealand Bariatric Surgery Registry between 2014 to June 2022 were conducted. All patients who underwent robotic MBS (RMBS) were propensity score matched 1:1 to laparoscopic MBS (LMBS) within the Registry. Clinical outcomes were compared using conditional logistic regression analyses. A total of 66,232 patients were included (LMBS n = 65,322; RMBS n = 910) in the analysis. The majority of RMBS were gastric or duodenal-ileal bypasses, significantly higher than the LMBS cohort (49.6 vs 24.3%, p < 0.0001) and more were revisional procedures (26% vs 19.6%, p < 0.0001). On direct comparison, there were significantly more defined adverse events in the RMBS group. When adjusted for cofounders, clinical outcomes of RMBS were comparable to LMBS with no increased risks of defined adverse events or complications.

Robotic versus laparoscopic gastric bypass in bariatric surgery: a systematic review and meta-analysis on perioperative outcomes

BACKGROUND

Robotic-assisted surgery has emerged as a compelling approach to bariatric surgery. However, current literature has not consistently demonstrated superior outcomes to laparoscopic bariatric surgery to justify its higher cost. With its mechanical advantages, the potential gains from the robotic surgical platform are likely to be apparent in more complex cases such as gastric bypass, especially revisional cases.

OBJECTIVE

This systematic review and meta-analysis aimed to summarize the literature and evaluate the peri-operative outcomes of patients with obesity undergoing robotic gastric bypass versus laparoscopic gastric bypass surgery.

SETTING

Systematic review.

METHODS

A literature search of Embase, Medline, Pubmed, Cochrane library, and Google Scholar was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing outcomes of robotic and laparoscopic gastric bypass for obesity were included.

RESULTS

Twenty-eight eligible studies comprised a total of 82,155 patients; 9051 robotic bypass surgery (RBS) versus 73,104 laparoscopic bypass surgery (LBS) were included. All included studies compared Roux-en-Y gastric bypass. RBS was noted to have higher reoperation rate within 30 days (4.4% versus 3.4%; odds ratio 1.31 [95% CI, 1.04-1.66]; P = .027; I2 = 43.5%) than LBS. All other endpoints measured (complication rate, anastomotic leak, anastomotic stricture, surgical site infections, hospital readmission, length of stay, operative time, conversion rate and mortality) did not show any difference between RBS and LBS.

CONCLUSION

This systematic review and meta-analysis showed that there was no significant difference in key outcome measures in robotic versus laparoscopic gastric bypass. RBS was associated with a slightly higher reoperation rate and there was no reduction in overall complication rate with the use of robotic platform.