Comparison of Surgical Outcomes Between Totally-robotic and Conventional Laparoscopy in Gastric Bypass Surgery: A Systematic Review

Richie G Goriparthi, MD, MSc, Shah-Jalal Sarker, BScHons, MSc, PhD, Sundus Makkiyah, MBChB, , MSc, Badriya S Alaraimi, MD, Walid S Elbakbak, MBBCh, MSc, Hitendra R H Patel, PhD, FRCS, FRCS, Bijendra Patel, MS, FRCS, FRCS

Barts Cancer Institute, Queen Mary, University of London

INTRODUCTION: Totally robotic Roux-en-y gastric bypass (TRRYGB) has certain advantages using the robotic system such as better ergonomics and 3-dimensional vision. Thus, the integration of robotic surgery into regular use, should have significantly lower complication rates than laparoscopic Roux-en-y gastric bypass surgery (LRYGB).
This systematic review compared TRRYGB with conventional LRYGB in terms of operative time, conversions, complications, duration of hospital stay and mortality rate.

METHODS AND PROCEDURES: The literature search was performed in PubMed and Cochrane databases. Inclusion criteria were English articles, from year 2000, humans, adults (>18yrs), da Vinci robotic systems and sample size >5. The search was performed separately for robotic surgery and conventional laparoscopy with the above criteria. Data were limited to randomized clinical trials (RCT’s) only for LRYGB. For TRRYGB, all the available evidence with totally-robotic technique was considered except case reports. Proportion test was performed to test the difference in complications, conversions and mortality rates between the two surgical procedures. Mann-Whitney U test was performed to test the duration of hospital stay and operative times. Bonferroni correction was also performed to adjust for multiple testing. This review followed PRISMA 2009 guidelines.

RESULTS: 4 TRRYGB studies (n=158) and 26 RCT’s in LRYGB (n=2143) were reviewed.

Anastomotic stricture5.97%3.16%0.14
Anastomotic leak1.07%0%0.67
Gastro-gastric fistula0.23%0%0.54
Bowel Obstruction1.95%0.63%0.23
Internal hernia0.74%0.63%0.87
Marginal ulcer1.3%1.26%0.23
Bleeding requiring intervention1.63%0%0.11
Operative time145.94 mins184.61 mins0.004*
Mean duration of hospital stay3.08 days 3.99 days0.6
Mortality rate0.13%0%0.6

*statistically significant difference at 5% level of significance

CONCLUSIONS: Most of the surgical outcomes were better in TRRYGB. However, TRRYGB had significantly longer operative times and higher conversion rate to both open and conventional laparoscopy. Robotic gastric bypass is as effective as conventional laparoscopy.

Session: Poster Presentation

Program Number: P469

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