Outcomes of robotic surgery in revisional bariatric cases: a propensity score-matched analysis of the MBSAQIP registry

Chaar, Maher El; King, Keith; Pastrana, Marlon; Galvez, Alvaro; Stoltzfus, Jill

doi:10.1007/s11701-020-01098-z

Cited by 19 publications

(6 citation statements)

References 17 publications

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“…Nevertheless, laparoscopic surgery is not immune to limitations, which include a loss of degrees of freedom in a confined space, restricted rotational motion, reduced depth perception, a two-dimensional video system, spatial disorientation, decreased haptic feedback, significant ergonomic challenges, and interference of the natural coupling of the surgeon’s eyes and hands by an independently moving video camera. Owing to these limitations, there has been a surge in the adoption of new forms of minimally invasive surgery, such as robotic surgery [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Robotic versus laparoscopic revisional bariatric surgeries: a systematic review and meta-analysis

Ataya,

El Bourji,

Bsat

et al. 2023

J Minim Invasive Surg

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Purpose In recent years, the need for revisional bariatric surgery (RBS) procedures has experienced a noteworthy surge to confront complexities and weight recidivism. Despite being a subject of controversy for many, the utilization of the Da Vinci robotic platform (Intuitive Surgical, Inc.) may present benefits in RBS. This study aimed to evaluate the outcomes of robotic RBS in comparison to Laparoscopic RBS. Methods A meticulous and thorough analysis was ensured through a comprehensive exploration of the literature, which included PubMed, Medline, Scopus, and Cochrane. This exploration was conducted in adherence to the directives outlined in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Newcastle-Ottawa scale was used for quality assessment. Results A total of 11 studies were included in this meta-analysis, comprising 55,889 in the laparoscopic group and 5,809 in the robotic group. No significant differences were observed in the leak, bleeding, operative time, or length of stay across both groups. However, the robotic group showed higher rates of conversion to open surgery (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.53–0.79; p < 0.0001; I 2 = 0%), reoperation (OR, 0.70; 95% CI, 0.57–0.87; p = 0.0009; I 2 = 6%), and readmission (higher rate of readmission in the robotic group; OR, 0.76; 95% CI, 0.62–0.92; p = 0.005; I 2 = 30%) Conclusion Robotic-assisted bariatric surgery has no significant advantage over conventional laparoscopic surgery. Further research is warranted to explore and evaluate surgeons’ methodology and proficiency differences.

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Section: Discussionmentioning

confidence: 99%

“…The Newcastle-Ottawa quality assessment scale (NOS) 7 in Table 1 [3,[6][7][8][9][10][11][12][13][14][15] was used as an evaluation tool to assess nonrandomized controlled trials (non-RCTs). This scale ranges from 0 to 9 stars.…”

Section: Quality and Publication Bias Evaluationmentioning

confidence: 99%

Robotic versus laparoscopic revisional bariatric surgeries: a systematic review and meta-analysis

Ataya,

El Bourji,

Bsat

et al. 2023

J Minim Invasive Surg

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“…Three studies conducted comparisons of revisional laparoscopic SG vs. robot-assisted SG, and revisional laparoscopic RYGB vs. robot-assisted RYGB [ 55 , 56 , 57 ]. Acevedo et al [ 55 ] reported a higher rate of transfusion requirements in the laparoscopic RYGB group (2.9% vs. robot-assisted RYGB 0.6%, p = 0.02), and a higher rate of postoperative sepsis in the robot-assisted SG group when compared to the laparoscopic group (1.0% vs. 0%, p = 0.04).…”

Section: Robot-assisted Vs Laparoscopic Revisional Bariatric Surgerymentioning

confidence: 99%

“…Acevedo et al [ 55 ] reported a higher rate of transfusion requirements in the laparoscopic RYGB group (2.9% vs. robot-assisted RYGB 0.6%, p = 0.02), and a higher rate of postoperative sepsis in the robot-assisted SG group when compared to the laparoscopic group (1.0% vs. 0%, p = 0.04). El Chaar et al [ 56 ] only found a trend towards decreased rates of serious adverse events and organ-specific infections in the robot-assisted RYGB group. Interestingly, after adjusting the outcomes for operative time, Nasser et al [ 57 ] still found a higher rate of organ-space surgical site infection and sepsis in robot-assisted SG vs. laparoscopic SG, whereas robot-assisted RYGB had a lower overall morbidity profile (lower rate of respiratory complications, pneumonia, surgical site infection, and bleeding requiring transfusion) than laparoscopic RYGB (AOR 0.74, p = 0.01).…”

Section: Robot-assisted Vs Laparoscopic Revisional Bariatric Surgerymentioning

confidence: 99%

Current Status of Robot-Assisted Revisional Bariatric Surgery

Vanetta

Dreifuss

Schlottmann

et al. 2022

JCM

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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.

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“…However, concerns regarding the increased cost and longer operative time limited its widespread adoption in bariatric surgery. Although there is conflicting data in literature, the robotic approach for RBS seems to have a similar safety profile when compared to the laparoscopic approach (7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 98%

Minimally Invasive Revisional Bariatric Surgery in a MBSAQIP Accredited High-Volume Center

et al. 2022

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BackgroundWith the rising number of bariatric surgeries performed annually, there has also been an increase in revisional bariatric surgeries (RBS). The aim of this study is to evaluate the safety and postoperative outcomes of RBS performed with a minimally invasive approach.MethodsRetrospective analysis on a prospectively collected database of patients who underwent minimally invasive RBS between 2012 and 2019. Primary endpoints were conversion rate, major morbidity, mortality, and 30-day reoperation rate. Comparative analysis of laparoscopic adjustable gastric banding (LAGB) conversion to sleeve gastrectomy (SG) vs. conversion to Roux-en-Y gastric bypass (RYGB) was performed.ResultsA total of 221 patients underwent minimally invasive RBS, 137 (62%) laparoscopically and 84 (38%) robotically. The most common RBS were LAGB to SG (59.3%) and LAGB to RYGB conversions (16.7%). The main indication was weight loss failure (88.7%). Conversion rate, major morbidity, and mortality were 0.9, 3.2, and 0.4%, respectively. Urgent reoperation was required in 3.2% of cases. Total weight loss at 1 and 2-years follow- were 14.3 and 17.3%, respectively. Comparative analysis of LAGB conversion to SG vs. RYGB showed similar major morbidity (SG: 2.3% vs. RYGB 0%, p = 1). Greater total weight loss was achieved in LAGB to RYGB conversions at 1-year (SG: 14.8% vs. RYGB 25.3%, p < 0.001).ConclusionsMinimally invasive RBS can be performed safely in a broad patient population with low conversion and complication rates, and improved weight loss outcomes. LAGB to RYGB conversions are associated with greater weight loss. Further randomized trials are needed to draw more conclusive recommendations.

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Outcomes of robotic surgery in revisional bariatric cases: a propensity score-matched analysis of the MBSAQIP registry

Cited by 19 publications

References 17 publications

Robotic versus laparoscopic revisional bariatric surgeries: a systematic review and meta-analysis

Robotic versus laparoscopic revisional bariatric surgeries: a systematic review and meta-analysis

Current Status of Robot-Assisted Revisional Bariatric Surgery

Minimally Invasive Revisional Bariatric Surgery in a MBSAQIP Accredited High-Volume Center

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