Abstract
Background
The laparoscopic approach is utilized in greater than 90% of bariatric surgeries. With the growing prevalence of robotic-assisted surgery in bariatrics, there has been limited consensus on the superiority of either laparoscopic or robotic approaches, especially in revisional procedures (conversion from sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB)).
Methods
A retrospective analysis was performed of the MBSAQIP PUF database of patients who underwent conversion from SG to RYGB procedures in either laparoscopic or robotic-assisted approaches. The groups underwent 2:1 propensity matching and primary outcomes included post-conversion days until discharge (POD), conversion operation length, total and major morbidity, 30-day readmission, 30-day reoperation, 30-day reintervention, and 30-day mortality after conversion.
Results
After 2:1 propensity score matching, 3411 patients (2274 laparoscopic vs 1137 robotic) were included in the study. Intraoperatively, no significant difference was found in total morbidity (6.5% lap vs 5.9% robotic) or major morbidity (1.9% lap vs 1.7% robotic); however, the operative times were significantly longer robotically (126 min vs 164 min). Post-operatively, no significant differences were found in discharge day (1.8 lap vs 1.8 robotic), 30-day readmission (7.6% lap vs 8.6% robotic), reoperation rate (2.9% lap vs 3.7% robotic), additional intervention rate (2.5% lap vs 3.3% robotic), or 30-day mortality (0.1% vs 0.1%).
Conclusion
There is no significant difference in perioperative or intraoperative outcomes between laparoscopic and robotic-assisted SG to RYGB conversion procedures other than a longer operative time in the robotic approach, suggesting increased efficiency with the laparoscopic approach.
Graphical abstract
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Authors Tristan Seton MD, Mark Mahan DO, James Dove BS, Hugo Villanueva MD, Vladan Obradovic MD, Alexandra Falvo MD, Ryan Horsley DO, Anthony Petrick MD, and David M Parker MD express no conflict of interest.
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Key Points
• There is no significant difference in intraoperative and 30-day post-operative outcomes in bariatric revisional procedures when comparing laparoscopic and robotic approaches.
• Revisions with the robotic approach took significantly longer intraoperatively than with the laparoscopic approach.
• The results of this analysis suggest that laparoscopy is a more efficient method than the robotic approach.
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Seton, T., Mahan, M., Dove, J. et al. Is Robotic Revisional Bariatric Surgery Justified? An MBSAQIP Analysis. OBES SURG 32, 3863–3868 (2022). https://doi.org/10.1007/s11695-022-06293-5
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DOI: https://doi.org/10.1007/s11695-022-06293-5