Robotic bariatric surgery for the obesity: a systematic review and meta-analysis

Zhang, Zhengchao; Miao, Lele; Ren, Zhijian; Li, Yumin

doi:10.1007/s00464-020-08283-z

Cited by 37 publications

(16 citation statements)

References 53 publications

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“…Interestingly, in our study, the median post-operative length of stay was almost significantly shorter in the robotic group. Zhang et al [44] reported comparable length of stay for the two approaches and this is similar to the outcome reported by Al-Mazrou [36]. Different results in favor of the robotic approach were reported in other studies [16,45].…”

Section: Discussionsupporting

confidence: 77%

“…In the comparative study of Al-Mazrou et al [36] after multivariable analysis, there was no difference in overall complications, organ space infection, sepsis, or mortality between robotic and laparoscopic BPD-DS. Similarly, Zhang et al [44] in their comprehensive systematic meta-analysis reported comparable leak, pulmonary embolism, estimated blood loss and stricture. Al-Mazrou et al [36], not surprisingly, reported more deep thrombosis in robotic group, but this is probably attributable to its longer mean operative time.…”

Section: Discussionmentioning

confidence: 74%

“…Al-Mazrou et al [36] reported longer mean operative time in robotic BDP-DS (219.2 vs 137.1; p < 0.001). Zhang et al [44] in their meta-analysis showed that operative time was longer in robotic operations. A few studies reported the opposite [45,46].…”

Section: Discussionmentioning

confidence: 99%

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Robotic vs laparoscopic approach for single anastomosis duodenal-ileal bypass with sleeve gastrectomy: a propensity score matching analysis

et al. 2022

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Biliopancreatic diversion with duodenal switch and single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) are technically demanding hypo-absorptive bariatric procedures. They are often indicated in superobese patients (BMI ≥ 50 kg/m2), as robotic platform could improve ergonomics against a thick abdominal wall, preventing bending of instruments and simplifying hand-sewn anastomoses. We aimed to report our experience with robotic SADI-S (R-group) and to compare outcomes with the laparoscopic (L-group) approach. Among 2143 patients who underwent bariatric procedures at our institution between July 2016 and June 2021, 116 (5.4%) consenting patients were scheduled for SADI-S as primary or revisional procedure: 94 L-group, 22 R-group. R-group and L-group patients were matched using PSM analysis to overcome patients selection bias. Postoperative complications, operative time (OT), post-operative stay (POS) and follow-up data were compared. After PSM, 44 patients (22 patients for each group) were compared (Chi-square 0.317, p = 0.985). Median age, gender, median BMI, preoperative rates of comorbidities, previous abdominal bariatric and non-bariatric surgeries and type of surgical procedures (SADI-S/SADI) were comparable. Median OT was shorter in the L-group (130 Vs 191 min, p < 0.001). 30-days’ re-operative complications and late complications rates were comparable. At 25-months’ mean follow-up, the median Percentage Excess Weight Loss (72%) was comparable between the groups (p = 0.989). L-group and R-group were comparable in terms of re-operative complication rate and short-term outcomes. The robotic platform may increase the rate of single step procedure in challenging cases. Larger studies with longer follow-up and cost-analysis are necessary to draw definitive conclusions.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 74%

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Robotic vs laparoscopic approach for single anastomosis duodenal-ileal bypass with sleeve gastrectomy: a propensity score matching analysis

et al. 2022

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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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“…[4][5][6][7] Furthermore, pulmonary complications also increase the 30day incidences of re-operation, re-intervention, and readmission after bariatric surgery. [5][6][7] The high demand of oxygen therapy in general postoperative patients is an important clinical problem. A multicenter study in the United States showed that 33.4% of postoperative patients developed at least one postoperative pulmonary complication (PPC), of which 19.6% of patients needed prolonged use of supplemental oxygen therapy by nasal cannula.…”

mentioning

confidence: 99%

Effectiveness of a Modified Nurse-Led COUGH Bundle for Obese Patients After Bariatric Surgery

Yang

Turner

Teh

et al. 2023

Journal of Nursing Care Quality

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Background: Obesity commonly affects postsurgical pulmonary outcomes and is associated with increased oxygen usage, length of recovery and hospital stay, discharge to high levels of care, cost, morbidity, and mortality. Local Problem: No standardized pulmonary care bundle for obese patients after bariatric surgery was available in the postanesthesia care unit (PACU) at a hospital in Singapore. Methods: This quality improvement project was a prospective, single-cohort, pre- and posttest intervention design with 151 patients recruited. Interventions: Teaching and implementation of a modified nurse-led COUGH bundle was carried out on obese patients after their bariatric surgery. Results: Postbariatric surgery patients with the nurse-led COUGH bundle had significantly less consumption of oxygen in the PACU and step-down units. The PACU and hospital length of stay were also reduced. Conclusions: The modified nurse-led COUGH bundle can reduce patients' oxygen usage and hospital stay after their bariatric surgery.

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Robotic bariatric surgery for the obesity: a systematic review and meta-analysis

Cited by 37 publications

References 53 publications

Robotic vs laparoscopic approach for single anastomosis duodenal-ileal bypass with sleeve gastrectomy: a propensity score matching analysis

Robotic vs laparoscopic approach for single anastomosis duodenal-ileal bypass with sleeve gastrectomy: a propensity score matching analysis

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

Effectiveness of a Modified Nurse-Led COUGH Bundle for Obese Patients After Bariatric Surgery

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