A Comparative Study of Robotic and Laparoscopic Gastric Bypass as a Treatment for Morbid Obesity

Anthony M Gonzalez, MD, FACS, FASMBS, Jorge R Rabaza, MD, FACS, FASMBS, Rupa Seetharamaiah, MD, FACS, Charan Donkor, MD, Rey Romero, MD, Radomir Kosanovic, MD, Jonathan Arad, MD

Baptist Health South Florida, Florida International University Herbert Wertheim College of Medicine

INTRODUCTION: The use of Minimally Invasive Surgery in the treatment of morbid obesity has gained popularity due to its apparent effectiveness, lower complication rates and patient satisfaction. For many years, laparoscopic gastric bypass has been the conventional method of choice due to its lower rate of complications (i.e. leaking, bleeding, strictures) when compared to the open approach (G. Banka et al Archives of Surgery 2012). The use of the daVinci robotic surgical system in bariatric surgery has seen increased popularity due to its numerous advantages, i.e. 3-D visualization, articulation of instruments and improved surgeon ergonomics . Until now, only a few small studies have been published contrasting the benefits and outcomes between robotic and laparoscopic gastric bypass surgeries. The purpose of this study is to compare our experiences between Robotic Gastric Bypass (RGB) and Laparoscopic Gastric Bypass (LGB) for the treatment of morbid obesity.

METHODS: We retrospectively collected, under IRB approval, RGB & LGB data from (08/2009-05/2012 & 09/2007-10/2009, respectively) that was performed by two surgeons at a single surgery center. All of the robotic procedures were completed using the daVinci® Surgical System. Follow up was achieved at 1-3, 4-6, 7-9, and >12 months after surgery. Information was collected focusing on surgical time, hospital length of stay, preoperative BMI, perioperative complications (abscess formation, leakage, strictures and bleeding), rate of internal hernia’s and Excess of Weight loss Percentage (EWL%).

RESULTS: This study included 165 RGB and 165 LGB patients. Mean age was 44.7(±13.3) and 41.4(±10.9) years old (P= 0.02) and mean initial BMI was 47.4(±9.8) and 48.4(±7.7) kg/m2 (P= 0.31), for RGB and LGB respectively. Mean surgical time in our RGB cohort was 140.7 compared to 102 min in our LGB cohort (P< 0.01) while the mean length of hospital stay was 2.6(±2.4) vs. 2.2(±1.2) days (P=0.08) respectively. Perioperative complications included: abscess formation was seen in no RGB and 2 LGB (P=0.2); strictures seen in 1 RGB and 1 LGB (P= 0.02); bleeding seen in 3 RGB and 5 LGB (P= 0.08) and no leaks were noted in either cohort. Additionally, an incisional hernia was found in 1 RGB and none in LGB (P=0.3). Postoperative follow up in both groups (RGB vs. LGB) was conducted at 1-3, 4-6, 7-9 and >12 months showing an EWL% of 25.1% vs. 22.6%, 46.5% vs. 46.1%, 57.6% vs. 62.1% and 68.9% vs. 67% respectively.

CONCLUSIONS: Our study exhibited that RGB is a safe procedure when used for weight loss in bariatric surgery, showing comparable weight loss results as those seen with the laparoscopic approach, with the progression toward lower complication rates of bleeding and abscess formation. Further studies with larger numbers and randomization are needed.

Session: Poster Presentation

Program Number: P425

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