The Impact of Robotics in Learning Roux-en-Y Gastric Bypass: a Retrospective Analysis of 214 Laparoscopic and Robotic Procedures

Abstract

Background Proximal Roux-en-Y gastric bypass is commonly used to manage obesity, performed using laparoscopic or robotassisted minimally invasive surgery. As the prevalence of robotic bariatric surgery increases, further data is required to justify its use. Methods This was a large, retrospective analysis of prospectively recorded data for Roux-en-Y gastric bypass (RYGB) procedures performed using laparoscopic (LRYGB) or robotic (RRYGB; da Vinci Xi system, Intuitive Surgical Sàrl) surgery between January 2016 and March 2019. The surgical techniques did not differ apart from different trocar placements. Data collected included patient characteristics before and after RYGB, operative outcomes and complications. Results In total, 114 RRYGB and 108 LRYGB primary surgeries were performed. There were no significant differences between the groups, apart from a significantly shorter duration of surgery (116.9 vs. 128.9 min, respectively), lower C-reactive protein values at days 1 (31.1 vs. 44.1 mg/l) and 2 (50.3 vs. 77.8 mg/l) after the intervention, and overall complication rate (4.4 vs. 12.0%, Clavien-Dindo classification II-V) with RRYGB compared with LRYGB. There was a lower hemoglobin value in the postoperative course after RRYGB (12.1 vs. 12.6 g/dl, day 2). Conclusions In our experience, robotic RYGB has proven to be safe and efficient, with a shorter duration of surgery and lower rate of complications than laparoscopic RYGB. RRYGB is easier to learn and seems safer in less experienced centers. Increasing experience with the robotic system can reduce the duration of surgery over time. Further studies with higher evidence level are necessary to confirm our results.

Identification of Main Influencers of Surgical Efficiency and Variability Using Task-Level Objective Metrics: A Five-Year Robotic Sleeve Gastrectomy Case Series

“…Additional surgical activities beyond the nine distinct tasks were classified as other or surgical inactivity. The surgical task segmentation is a foundational component that enables the ability to perform focused and granular analysis than conventional learning curve analysis ( 8 , 30 , 31 ) for this RSG case series.…”

“…Although multiple factors influence outcomes and efficiencies, many studies focus on how surgery is performed by describing subjectively initial case series or critical aspects within the procedure. Few studies use objective methods to identify which surgical activities and how surgeon performance affect overall procedure efficiency or surgical outcomes throughout a surgeon's learning curve ( 4 – 8 ). These studies are largely agnostic to the underlying surgical activities by using global subjective rating scales like Global Evaluative Assessment of Robotic Skills (GEARS) ( 9 ) or Objective Structured Assessment of Technical Skills (OSATS) ( 10 ).…”

Bariatric surgery in patients with obstructive sleep apnea

“…Initially, the use of robotic surgery prolonged the surgical duration and anesthesia duration due to a steep learning curve with equilibration as surgeons' experience with robotic surgery increased. 12 The use of endoscopic obesity treatments has also evolved and become more widespread. 97 Currently, it is unclear in what way the patient with OSA may be affected by these new trends and what needs to be adjusted in their perioperative care.…”

Robotic Roux-en-Y Gastric Bypass Procedure Guide

“…We implemented our robotic program in 2013 and have performed more than 1400 robotic-assisted surgeries ever since, using both the da Vinci SI and XI systems (Intuitive Surgical Sàrl). After gaining experience in hepatobiliary, colorectal, esophageal, and thoracic robotic surgery, 10 – 13 the system was also introduced into our bariatric program in 2016. Since then, more than 200 robotic Roux-en-Y gastric bypass (RRYGB) surgeries and 50 re-do surgeries have been performed in our institution.…”

“…Since then, more than 200 robotic Roux-en-Y gastric bypass (RRYGB) surgeries and 50 re-do surgeries have been performed in our institution. 13 In this article, we present our standardized technique for RRYGB, offer suggestions for successful implementation, highlight potential solutions for common problems, and discuss different technical aspects.…”