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Improving Operating Room Efficiency of Robotic-Assisted Metabolic and Bariatric Surgery Through Standardization

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Abstract

Introduction

The use of robotic-assisted (RA) surgery in the field of metabolic and bariatric surgery (MBS) is controversial because of cost concerns and issues related to efficiency. The objective of this study is to evaluate the operating room efficiency in performing RA-MBS prior and after the implementation of a standardized surgical approach.

Materials and Methods

All MBS cases entered into our database between October 2017 and October 2022 were collected and analyzed before and after the introduction of the standardized approach (SA). The outcome variables consisted of operation time (OT), turnover time (TT), wheels in-wheels out (WW), and console time (CT). Procedures were divided into Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and revisional bariatric surgery (RBS).

Results

For RYGB (n = 185), we found a significant reduction in OT, TT, and WW after SA (129 min vs 139 min; 37 min vs 73 min; 165 min vs 175 min, respectively, p < 0.05). For SG (n = 253), we found a significant reduction in turnover time (TT) after SA. For RBS (n = 201), we also found a significant reduction in OT, TT, WW, and CT after SA ( 157 min vs 177 min; 36 min vs 72 min; 194 min vs 216 min; 119 min vs 134 min, respectively, p < 0.05).

Conclusion

Using a standardized surgical approach, we were able to demonstrate improved operation room efficiency as demonstrated by a reduction in operation length, turnover time, and the overall time of the procedure for primary RYGB and revisional procedures and turnover time for primary sleeve procedures.

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References

  1. Evans M, Anupindi VR, DeKoven M, et al. Eight-year trends in obesity-related complications and health care cost progression in a US population with obesity: a retrospective cohort study. Diabetes Obes Metabolism. 2023;25:536–44.

    Article  Google Scholar 

  2. Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24:437–55.

    Article  CAS  PubMed  Google Scholar 

  3. English WJ, DeMaria EJ, Hutter MM, et al. American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis. 2020;16:457–63.

    Article  PubMed  Google Scholar 

  4. Telem DA, Talamini M, Altieri M, et al. The effect of national hospital accreditation in bariatric surgery on perioperative outcomes and long-term mortality. Surg Obes Relat Dis. 2015;11:749–57.

    Article  PubMed  Google Scholar 

  5. Bauerle WB, Mody P, Estep A, et al. Current trends in the utilization of a robotic approach in the field of bariatric surgery. Obes Surg. 2023;33:482–91.

    Article  PubMed  Google Scholar 

  6. Villamere J, Gebhart A, Vu S, et al. Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at Academic Medical Centers. Surg Endosc. 2015;29:1729–36.

    Article  PubMed  Google Scholar 

  7. Chaar ME, Stoltzfus J, Melitics M, et al. 30-day outcomes of revisional bariatric stapling procedures: first report based on MBSAQIP Data Registry. Obes Surg. 2018;28:2233–40.

    Article  PubMed  Google Scholar 

  8. Lundberg PW, Stoltzfus J, Chaar ME. 30-day outcomes of robot-assisted versus conventional laparoscopic sleeve gastrectomy: first analysis based on MBSAQIP. Surg Obes Relat Dis. 2019;15:1–7.

    Article  PubMed  Google Scholar 

  9. Papasavas P, Chaar ME, Kothari SN. Committee on behalf of the AS for M and BSCI. American Society for Metabolic and Bariatric Surgery position statement on vagal blocking therapy for obesity. Surg Obes Relat Dis. 2016;12:460–1.

    Article  PubMed  Google Scholar 

  10. Nasser H, Munie S, Kindel TL, et al. Comparative analysis of robotic versus laparoscopic revisional bariatric surgery: perioperative outcomes from the MBSAQIP database. Surg Obes Relat Dis. 2020;16:397–405.

    Article  PubMed  Google Scholar 

  11. Wehrtmann FS, de la Garza JR, Kowalewski KF, et al. Learning curves of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in bariatric surgery: a systematic review and introduction of a standardization. Obes Surg. 2020;30:640–56.

    Article  CAS  PubMed  Google Scholar 

  12. Petrick AT, Rosenthal R, Wood C. Understanding the causes of conflicting outcomes reported using the same cohorts from the MBASQIP PUF data registry. Surg Obes Relat Dis. 2021;17:e42–5.

    Article  PubMed  Google Scholar 

  13. Chaar ME, Petrick A, Clapp B, et al. Outcomes of robotic-assisted bariatric surgery compared to standard laparoscopic approach using a standardized definition: first look at the 2020 Metabolic and Bariatric Surgery Accreditation Quality Improvement Project (MBSAQIP) data. Obes Surg. 2023;33:2025–39.

  14. King K, Galvez A, Stoltzfus J, et al. Cost Analysis of Robotic Roux-en-Y gastric bypass in a single academic center: how expensive is expensive? Obes Surg. 2020;30:4860–6.

    Article  PubMed  Google Scholar 

  15. Chaar ME, Gacke J, Ringold S, et al. Cost analysis of robotic sleeve gastrectomy (R-SG) compared with laparoscopic sleeve gastrectomy (L-SG) in a single academic center: debunking a myth! Surg Obes Relat Dis. 2019;15:675–9.

    Article  PubMed  Google Scholar 

  16. Acevedo E, Mazzei M, Zhao H, et al. Outcomes in conventional laparoscopic versus robotic-assisted primary bariatric surgery: a retrospective, case–controlled study of the MBSAQIP database. Surg Endosc. 2020;34:1353–65.

    Article  PubMed  Google Scholar 

  17. Chaar ME, King K, Pastrana M, et al. Outcomes of robotic surgery in revisional bariatric cases: a propensity score-matched analysis of the MBSAQIP registry. J Robotic Surg. 2021;15:235–9.

    Article  Google Scholar 

  18. Clapp B, Liggett E, Jones R, et al. Comparison of robotic revisional weight loss surgery and laparoscopic revisional weight loss surgery using the MBSAQIP database. Surg Obes Relat Dis. 2019;15:909–19.

    Article  PubMed  Google Scholar 

  19. Tatarian T, Yang J, Wang J, et al. Trends in the utilization and perioperative outcomes of primary robotic bariatric surgery from 2015 to 2018: a study of 46,764 patients from the MBSAQIP data registry. Surg Endosc. 2021;35:3915–22.

    Article  PubMed  Google Scholar 

  20. Pastrana M, Stoltzfus J, AlMandini A, et al. Evolution of outcomes of robotic bariatric surgery: first report based on MBSAQIP database. Surg Obes Relat Dis. 2020;16:916–22.

    Article  PubMed  Google Scholar 

  21. Dudash M, Kuhn J, Dove J, et al. The longitudinal efficiency of robotic surgery: an MBSAQIP propensity matched 4-year comparison of robotic and laparoscopic bariatric surgery. Obes Surg. 2020;30:3706–13.

    Article  PubMed  Google Scholar 

  22. Kannan U, Ecker BL, Choudhury R, et al. Laparoscopic hand-assisted versus robotic-assisted laparoscopic sleeve gastrectomy: experience of 103 consecutive cases. Surg Obes Relat Dis. 2016;12:94–9.

    Article  PubMed  Google Scholar 

  23. Ecker BL, Maduka R, Ramdon A, et al. Resident education in robotic-assisted vertical sleeve gastrectomy: outcomes and cost-analysis of 411 consecutive cases. Surg Obes Relat Dis. 2016;12:313–20.

    Article  PubMed  Google Scholar 

  24. Pernar LIM, Robertson FC, Tavakkoli A, et al. An appraisal of the learning curve in robotic general surgery. Surg Endosc. 2017;31:4583–96.

    Article  PubMed  Google Scholar 

  25. Jain M, Fry BT, Hess LW, et al. Barriers to efficiency in robotic surgery: the resident effect. J Surg Res. 2016;205:296–304.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Cofran L, Cohen T, Alfred M, et al. Barriers to safety and efficiency in robotic surgery docking. Surg Endosc. 2022;36:206–15.

    Article  PubMed  Google Scholar 

  27. Urrego H, Sanni A, Toro JP, et al. Out by 3:30—a study in robotic bariatric surgery efficiency. Bariatr Surg Pract P. 2014;9:55–60.

    Google Scholar 

  28. Feuer G, Hernandez P, Barker J. Surgical technique enhances the efficiency of robotic hysterectomy. Int J Medical Robotics Comput Assisted Surg. 2011;7:1–6.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, St. Luke’s University Hospital and Health Network, 1736 Hamilton Street, Allentown, PA, 18104, USA

    Maher El Chaar

  2. St. Luke’s University Hospital and Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA

    Allincia Michaud, Jill Stoltzfus & Luis A. Alvarado

Authors
  1. Maher El Chaar
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  2. Allincia Michaud
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  3. Jill Stoltzfus
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  4. Luis A. Alvarado
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Corresponding author

Correspondence to Maher El Chaar.

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Dr. Maher El Chaar is a paid faculty for Intuitive surgical; none of the other authors have any disclosures.

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Key Points

1. The use of robotic-assisted (RA) surgery in the field of metabolic and bariatric surgery (MBS) is controversial because of cost concerns and issues related to efficiency.

2. The objective of this study is to evaluate the difference in operating room efficiency prior and after the implementation of our standardized approach.

3. Using a standardized surgical approach for all MBS at our institution, we were able to demonstrate improved operation room efficiency through a reduction in operation length, turnover time, and the overall time of the procedure.

4. Improvement in OR efficiency during the performance of robotic-assisted surgery in the field of MBS can potentially decrease healthcare costs and increase adoption rate.

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El Chaar, M., Michaud, A., Stoltzfus, J. et al. Improving Operating Room Efficiency of Robotic-Assisted Metabolic and Bariatric Surgery Through Standardization. OBES SURG 33, 3411–3421 (2023). https://doi.org/10.1007/s11695-023-06850-6

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  • DOI: https://doi.org/10.1007/s11695-023-06850-6

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