USE OF ROBOTIC PLATFORMS IS SAFE IN ELECTIVE BARIATRIC SURGERY: AN ANALYSIS OF THE MBSAQIP DATABASE
Bhavani Pokala*, Priscila R. Armijo, Sarah Samreen, Dmitry Oleynikov
University of Nebraska Medical Center, Omaha, NE
Introduction
Robotic-assisted approach has been proven to overcome laparoscopy in several surgical subspecialties, such as urology and OB/GYN. In bariatrics, however, rates of robotic utilization are very low, and its benefits over laparoscopy remain highly contentious. Our aim was to examine perioperative factors and clinical outcomes of laparoscopic versus robotic-assisted approach for both Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB).
Methods
The 2016 and 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) databases were analyzed for adult patients who underwent elective laparoscopic (L) or robotic-assisted (R) SG or RYGB. Emergent cases, patients with previous foregut or revisional surgery, and those unable to be followed for 30 days were excluded. Data including patient demographics, intra-operative factors, and post-operative complications was collected. Comparisons were performed between laparoscopic and robotic-assisted surgical approach within each procedure group. Statistical analysis was performed using IBM SPSS 25.0, α=0.05.
Results
202,642 SG patients (LSG= 187,113, RSG=15,529) and 74,430 RYGB patients (LRYGB=68,652, RRYGB=5,778) were included in the study. As expected, robotic approach was associated with significantly longer operative times for SG (LSG: 69.48 ± 34.66 vs RSG: 97.14 ± 43.91 min; p=<.001) and RYGB (LRYGB: 116.22±51.63 vs RRYGB: 156.17±63.42 min; p<.001). Staple line reinforcement was more likely to be used with LSG than RSG (67.3% vs 63.7%; p=.001). Alternatively, sleeve was oversewn more frequently with RSG (26.6% vs 21.7%; p<.001). For both procedures, intra-operative drain utilization was higher with laparoscopic approach (SG= 14.1% vs 14.9%; p=.003; RYGB=27.1% vs 13.2%; p<.001).
There was no significant differences in mortality (SG: p=0.761; RYGB: p=0.050), overall complications (SG: p=0.308; RYGB: p=0.072), or reoperation (SG: p=0.942; RYGB: p=0.610) rates between laparoscopic and robotic approaches in both groups. Conversely, patients undergoing robotic procedures had a higher rate for readmission (SG: p=0.016; RYGB: p=0.014) and re-intervention (SG: p=0.004; RYGB: p=0.034), in both groups (Table 1).
Conclusions
Overall, our data shows robotic-assisted bariatric surgery to have similar short-term outcomes compared to laparoscopy. RSG and RRYGB have modestly increased rates of readmission and re-intervention. With increasing utilization of robotic platforms, we expect an increase in efficiency with corresponding decrease in operative time. Sleeve is oversewn more frequently with RSG while higher rates of staple line reinforcement is seen with LSG. Further studies could address differences in surgical techniques between laparoscopic and robotic approaches and their impact on surgical outcomes.
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