Robotic gastric bypass may lead to fewer complications compared with laparoscopy View Full Text


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Article Info

DATE

2018-02

AUTHORS

Dimitrios Stefanidis, Savannah B. Bailey, Timothy Kuwada, Connie Simms, Keith Gersin

ABSTRACT

BACKGROUND: Robotic technology leads to improved visualization and precision over laparoscopy but also higher cost of care. The benefits of this technology to patient outcomes are controversial. Our objective was to assess whether the application of robotic surgery to Roux-en-Y gastric bypass (RYGB) would lead to improved patient outcomes. METHODS: A prospectively collected database at a bariatric center of excellence was reviewed for all RYGB procedures performed by one surgeon between 2007 and 2015. Procedures performed laparoscopically (transoral circular stapling technique) versus robotically (hand-sewn anastomosis) were compared; the transition in technique occurred in 2011. Patient demographics, baseline weight, BMI, operation duration, estimated blood loss (EBL), length of hospital stay (LOS), morbidity and mortality, and percent excess weight loss (%EWL) at 1-year follow-up were compared between groups. Morbidity up to 1-year postop was assessed using the Clavien-Dindo classification. RESULTS: Of 246 patients, 125 underwent robotic and 121 laparoscopic RYGB. Patients in the robotic group were older and heavier but achieved similar %EWL to the laparoscopic group. The operative duration was longer but the mean patient LOS was shorter with the robotic approach. There were no leaks and no mortality. Based on the Clavien-Dindo classification, fewer overall and fewer severe complications occurred in the robotic compared with the laparoscopic approach. CONCLUSION: In our experience, the use of robotic technology for the creation of gastric bypass led to longer operative times, similar %EWL but decreased LOS and number and severity of complications compared with the laparoscopic approach. Since our findings may have been influenced by the type of anastomotic technique used with each approach they need confirmation by a controlled trial. More... »

PAGES

610-616

References to SciGraph publications

  • 2016-09. Laparoscopic versus robotic-assisted Roux-en-Y gastric bypass: a retrospective, single-center study of early perioperative outcomes at a community hospital in SURGICAL ENDOSCOPY
  • 2016-06. The Results of 100 Robotic Versus 100 Laparoscopic Gastric Bypass Procedures: a Single High Volume Centre Experience in OBESITY SURGERY
  • 1998-06. Long-term maintenance of weight loss: do people who lose weight through various weight loss methods use different behaviors to maintain their weight? in INTERNATIONAL JOURNAL OF OBESITY
  • 2016-05. Robotic Roux-en-Y Gastric Bypass, is it Safer than Laparoscopic Bypass? in OBESITY SURGERY
  • 2017-03. A retrospective comparison of robotic cholecystectomy versus laparoscopic cholecystectomy: operative outcomes and cost analysis in SURGICAL ENDOSCOPY
  • 2014-02. Robotic versus laparoscopic Roux-en-Y gastric bypass (RYGB) in obese adults ages 18 to 65 years: a systematic review and economic analysis in SURGICAL ENDOSCOPY
  • 2015-11. Robotic vs. Laparoscopic Roux-En-Y Gastric Bypass: a Systematic Review and Meta-Analysis in OBESITY SURGERY
  • 2014-12. Laparoscopic Versus Robotic Roux-En-Y Gastric Bypass: Lessons and Long-Term Follow-Up Learned From a Large Prospective Monocentric Study in OBESITY SURGERY
  • 2016-06. Laparoscopic gastric bypass to robotic gastric bypass: time and cost commitment involved in training and transitioning an academic surgical practice in JOURNAL OF ROBOTIC SURGERY
  • 2017-01. Cost analysis of robotic versus laparoscopic general surgery procedures in SURGICAL ENDOSCOPY
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s00464-017-5710-y

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    DIMENSIONS

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/28726145


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    34 schema:description BACKGROUND: Robotic technology leads to improved visualization and precision over laparoscopy but also higher cost of care. The benefits of this technology to patient outcomes are controversial. Our objective was to assess whether the application of robotic surgery to Roux-en-Y gastric bypass (RYGB) would lead to improved patient outcomes. METHODS: A prospectively collected database at a bariatric center of excellence was reviewed for all RYGB procedures performed by one surgeon between 2007 and 2015. Procedures performed laparoscopically (transoral circular stapling technique) versus robotically (hand-sewn anastomosis) were compared; the transition in technique occurred in 2011. Patient demographics, baseline weight, BMI, operation duration, estimated blood loss (EBL), length of hospital stay (LOS), morbidity and mortality, and percent excess weight loss (%EWL) at 1-year follow-up were compared between groups. Morbidity up to 1-year postop was assessed using the Clavien-Dindo classification. RESULTS: Of 246 patients, 125 underwent robotic and 121 laparoscopic RYGB. Patients in the robotic group were older and heavier but achieved similar  %EWL to the laparoscopic group. The operative duration was longer but the mean patient LOS was shorter with the robotic approach. There were no leaks and no mortality. Based on the Clavien-Dindo classification, fewer overall and fewer severe complications occurred in the robotic compared with the laparoscopic approach. CONCLUSION: In our experience, the use of robotic technology for the creation of gastric bypass led to longer operative times, similar %EWL but decreased LOS and number and severity of complications compared with the laparoscopic approach. Since our findings may have been influenced by the type of anastomotic technique used with each approach they need confirmation by a controlled trial.
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