Role of Robotic Surgery in Complex Revisional Bariatric Procedures

Cheng, Yilon Lima; Elli, Enrique F.

doi:10.1007/s11695-021-05272-6

Cited by 14 publications

(6 citation statements)

References 46 publications

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“…Nevertheless, Cheng and Elli have previously shown that revision surgery was more susceptible to complications due to a technically more complicated operation, and that robotic surgery improved the treatment's safety. 28 Second, we employed novel matching modalities that reversed the findings that might have been obtained from the raw data from the database without adjusting for confounding variables. Hence, before matching, complications were more frequent following robotic-assisted surgeries, but this was no longer the case after matching.…”

Section: Discussionmentioning

confidence: 99%

“…Surprisingly, revisional surgery was not identified as a statistically significant independent factor impacting the probability of surgical complication or length of hospital stay. Nevertheless, Cheng and Elli have previously shown that revision surgery was more susceptible to complications due to a technically more complicated operation, and that robotic surgery improved the treatment’s safety 28 …”

Section: Discussionmentioning

confidence: 99%

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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%

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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“…For instance, 42.8% of the patients in the study by Ayloo et al [ 44 ] were conversions from AGB to SG. Similarly, Snyder et al [ 45 ] had 14.1% of these procedures among the subjects, while the RBS analyzed by Cheng et al [ 46 ] included 20.9% redo gastro-jejunostomy. Consistently, AGB was the most frequent index procedure among the studies, and failed (weight-related) primary surgery was the principal indication for revisional surgery.…”

Section: Outcomes Of Robot-assisted Revisional Bariatric Surgerymentioning

confidence: 99%

“…Regarding the complications of robot-assisted RBS, only three studies reported major morbidity outcomes (corresponding to a grade > 2 in the Clavien–Dindo classification) with rates of 2.9%, 3.9%, and 4.5% [ 46 , 48 , 49 ]. Considering the incidence of postoperative leaks, Dreifuss et al [ 49 ] reported only one case of anastomotic leak after a resection and reconstruction of a SG stenosis, and Cheng et al [ 46 ] reported a patient with abdominal fluid collection after a redo gastro-jejunal anastomosis that was managed with antibiotics and drainage. The conversion, reoperation, and mortality rates were almost negligible among all of the studies.…”

Section: Outcomes Of Robot-assisted Revisional Bariatric Surgerymentioning

confidence: 99%

“…The mean %EWL, follow-up time, and rates of loss to follow-up were variable among the studies. At 1 year, Rebecchi et al [ 48 ] and Cheng et al [ 46 ] reported 55.4% and 57.6% EWL, respectively, whereas at 2 years, Dreifuss et al [ 49 ] reported a 36.4% EWL and Bindal et al [ 50 ] reported a 60.7 mean %EWL. The study by Bindal et al [ 50 ] focused specifically on weight loss outcomes according to the type of RBS performed, and reported a %EWL at 2 years of up to 51.2% after conversion from SG to RYGB, and up to 70.1% after the conversion of AGB to RYGB.…”

Section: Outcomes Of Robot-assisted Revisional Bariatric Surgerymentioning

confidence: 99%

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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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Robotic Revisional Bariatric Surgery

Laan

Galvani

2021

Atlas of Robotic Upper Gastrointestinal Surgery

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Role of Robotic Surgery in Complex Revisional Bariatric Procedures

Cited by 14 publications

References 46 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

Current Status of Robot-Assisted Revisional Bariatric Surgery

Robotic Revisional Bariatric Surgery

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