Outcomes of robotic bariatric surgery in super-obese patients: first report based on MBSAQIP database

Pastrana, Marlon; Stoltzfus, Jill; Claros, Leonardo; Chaar, Maher El

doi:10.1016/j.soard.2019.10.009

Cited by 12 publications

(5 citation statements)

References 21 publications

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“…We believe that our work makes a positive contribution to promoting the robotic approach in BMS in the midst of muddled scientific literature where the examination of the same database might even provide contradictory results. 24,26,[29][30][31][32] Because of its 3D vision, image stability, and improved articulated tools, as well as the shorter duration of stay, robotic assistance may provide better outcomes in difficult cases than laparoscopy, even in the hands of experienced surgeons. However, more research is needed to evaluate whether this degree of LOS reduction helps to offset the additional expense of the robot in patients undergoing bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

Impact of Robotic Assistance on Complications in Bariatric Surgery at Expert Laparoscopic Surgery Centers

et al. 2023

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Objective: To investigate the way robotic assistance affected rate of complications in bariatric surgery at expert robotic and laparoscopic surgery facilities. Summary background data: While the benefits of robotic assistance were established at the beginning of surgical training, there is limited data on the robot’s influence on experienced bariatric laparoscopic surgeons. Methods: We conducted a retrospective study using the BRO clinical database (2008–2022) collecting data of patients operated on in expert centers. We compared the serious complication rate (defined as a Clavien score ≥3) in patients undergoing metabolic bariatric surgery with or without robotic assistance. We used a Directed Acyclic Graph to identify the variables adjustment set used in a multivariable linear regression, and a propensity score matching to calculate the Average Treatment Effect (ATE) of robotic assistance. Results: The study included 35,043 patients (24,428 SG; 10,452 RYGB; 163 SADI-S), with 938 operated on with robotic assistance (801 SG; 134 RYGB; 3 SADI-S), among 142 centers. Overall, we found no benefit of robotic assistance regarding the risk of complications (ATE= -0.05, P=0.794), with no difference in the RYGB+SADI group (P=0.322) but a negative trend in the SG group (more complications, P=0.060). Length of hospital stay was decreased in the robot group (3.7±11.1 vs. 4.0±9.0 d, P<0.001). Conclusion: Robotic assistance reduced the length of stay but did not statistically significantly reduce postoperative complications (Clavien score ≥3) following either GBP or SG. A tendency toward an elevated risk of complications following SG requires more supporting studies.

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Section: Discussionmentioning

confidence: 99%

Impact of Robotic Assistance on Complications in Bariatric Surgery at Expert Laparoscopic Surgery Centers

et al. 2023

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“…Nevertheless, the incidence of serious adverse events (such as deep-incisional surgical site infection, pulmonary embolism, pneumonia, stroke/cerebral vascular accident, etc.) remained high during minimally invasive SG (3.53%) and RYGB (7.23%) in super-obese patients 7 .…”

Section: Introductionmentioning

confidence: 92%

Efficacy and safety of enhanced recovery after surgery protocol on minimally invasive bariatric surgery: a meta-analysis

Gao

Chen

Liu

et al. 2023

International Journal of Surgery

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Background: Enhanced recovery after surgery (ERAS), a multidisciplinary and multimodal perioperative care protocol, has been widely used in several surgical fields. However, the effect of this care protocol on patients receiving minimally invasive bariatric surgery remains unclear. This meta-analysis compared the clinical outcomes of the ERAS protocol and standard care (SC) in patients who underwent minimally invasive bariatric surgery. Material and methods: PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched to identify literature reporting the effects of the ERAS protocol on clinical outcomes in patients undergoing minimally invasive bariatric surgery. All the articles published until 01 October 2022, were searched, followed by data extraction of the included literature and independent quality assessment. Then, pooled mean difference (MD) and odds ratio with a 95% CI were calculated by either a random-effects or fixed-effects model. Results: Overall, 21 studies involving 10 764 patients were included in the final analysis. With the ERAS protocol, the length of hospitalization (MD: −1.02, 95% CI: −1.41 to −0.64, P<0.00001), hospitalization costs (MD: −678.50, 95% CI: −1196.39 to −160.60, P=0.01), and the incidence of 30-day readmission (odds ratio =0.78, 95% CI: 0.63–0.97, P=0.02) were significantly reduced. The incidences of overall complications, major complications (Clavien–Dindo grade ≥3), postoperative nausea and vomiting, intra-abdominal bleeding, anastomotic leak, incisional infection, reoperation, and mortality did not differ significantly between the ERAS and SC groups. Conclusions: The current meta-analysis indicated that the ERAS protocol could be safely and feasibly implemented in the perioperative management of patients receiving minimally invasive bariatric surgery. Compared with SC, this protocol leads to significantly shorter hospitalization lengths, lower 30-day readmission rate, and hospitalization costs. However, no differences were observed in postoperative complications and mortality.

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“…Most of the previous reports showed similar results in terms of post-operative complications between the robotic and the laparoscopic procedures [ 26 – 28 ]. Nelson et al [ 29 ] analyzed 69 SO patients who underwent laparoscopic and robot-assisted SADI-S and demonstrated that both surgical approaches are feasible and safe options for these patients, with a mean post-operative hospital stay of 4.3 ± 2.6 days, 30 days-readmission rate of 4.3% and the 30 days-reoperation rate of 5.8%.…”

Section: Discussionmentioning

confidence: 64%

“…Unfortunately, the high costs of robotic procedures still represent a limit for their routinary use, even in challenging patients, who would benefit from the related-advantages of such technology to perform multi-quadrant surgeries [ 19 , 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted vs laparoscopic bariatric procedures in super-obese patients: clinical and economic outcomes

Marincola,

Procopio,

Pennestrì

et al. 2024

J Robotic Surg

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The increased operative time and costs represent the main limitations of robotic technology application to bariatric surgery. Robotic platforms may help the surgeon to overcome the technical difficulties in super-obese (SO, BMI ≥ 50 kg/m2) patients, in which multi-quadrant operations could be challenging. We aimed to evaluate the effect of robot-assisted (R) versus laparoscopic (L) approaches in Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) and Roux-en-Y Gastric Bypass (RYGB) in SO and Super-Super Obese (SSO, BMI ≥ 60 kg/m2) patients in terms of outcomes and cost-effectiveness. Bariatric procedures performed from 2012 to 2023 were retrospectively reviewed. The inclusion criteria were BMI ≥ 50 kg/m2, primary SADI-S or RYGB. Operative time (OT), early complications, post-operative stay (POS), overall costs and follow-up data were analyzed. A subgroup analysis for surgical procedures and SSO patients was also performed. Among 4596 patients, 174 RYGB and 91 SADI-S in BMI ≥ 50 kg/m2 patients were selected. After Propensity Score Matching analysis, two groups of patients were identified (laparoscopic and robot-assisted), each one composed of 18 RYGB and 26 SADI-S. Intraoperative and post-operative complication rates and POS were comparable. Mean OT was longer in robotic procedures compared with laparoscopy (199.1 ± 65.7 and 109.5 ± 39.1 min, respectively, p < 0.001). The difference in OT was eliminated after only SSO patients were included in the analysis (172.7 ± 24.1 vs 152.6 ± 26.2 min for R-SADI-S and L-SADI-S, respectively, p = 0.107). Robotic surgeries were associated with higher costs (8134.6 ± 1886.7 and 2386.7 ± 388.2 € in R-RYGB and L-RYGB, respectively; 7996.6 ± 873.1 and 3954.6 ± 631.1 € in R-SADI-S and L-SADI-S). Despite increased costs, robotic approach may represent an added value in more complex cases such as SSO patients.

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Outcomes of robotic bariatric surgery in super-obese patients: first report based on MBSAQIP database

Cited by 12 publications

References 21 publications

Impact of Robotic Assistance on Complications in Bariatric Surgery at Expert Laparoscopic Surgery Centers

Impact of Robotic Assistance on Complications in Bariatric Surgery at Expert Laparoscopic Surgery Centers

Efficacy and safety of enhanced recovery after surgery protocol on minimally invasive bariatric surgery: a meta-analysis

Robot-assisted vs laparoscopic bariatric procedures in super-obese patients: clinical and economic outcomes

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