Jackly M Juprasert, MD1, Francesca M Dimou, MD1, Lauren Tufts1, Katherine D Gray, MD1, Omar Bellorin, MD2, Gregory Dakin, MD1, Alfons Pomp, MD1, Cheguevara Afaneh, MD1. 1NewYork-Presbyterian Hospital/Weill Cornell Medicine, 2The Valley Hospital/Valley Health System
INTRODUCTION: The safety and efficacy of robotic bariatric surgery has been established. However, the learning curve has been variably documented and assessed. In this study, we describe our experience with the learning curve in robotic sleeve gastrectomy (RSG), robotic one-anastomosis bypass (ROAB), and robotic Roux-en-Y gastric bypass (RRYGB).
METHODS: Consecutive patients undergoing primary robotic bariatric surgery from October 2015 to July 2018 by a minimally invasive fellowship (MIF)-trained surgeon (Surgeon 1) during his first three years of attending practice were included. Demographic and perioperative data were collected via retrospective chart review. The primary outcome was the learning curve in RSG, RRYGB, and ROAB, represented as the change in operative time over the course of this study and calculated by linear regression fit lines over the number of procedures performed. Secondary outcomes were estimated blood loss (EBL), length of stay (LOS), 90-day readmission, and morbidity. To externally validate our single-surgeon results, we compared our data to Surgeon 2 who trained under Surgeon 1. We report on Surgeon 2’s learning curve and outcomes during his first year in practice in 2017. Resident and fellow participation did not change significantly throughout the study period.
RESULTS: A total of 241 patients undergoing RSG (n=162), RRYGB (n=53), and ROAB (n= 26) by Surgeon 1 were included. Median age was 42±12.5years (range 18-72). 75% were female. 67% of patients had ASA scores ≥3. Mean pre-operative BMI was 45.9±8.9 (23.3-92.5). Mean operative time for RSG for 2015-2016, 2016-2017, and 2017-2018 were 110±26 (73-185), 98.3±25 (60-211), and 90.8±24 (54-211) respectively. Mean operative time for RRYGB for 2015-2016, 2016-2017, and 2017-2018 were 200±36 (141-268), 178±44 (117-278), and 142±37 (87-278) respectively. Mean operative time for ROAB for 2016-2017 and 2017-2018 were 104±21 (72-142) and 98.2±19 (71-142) respectively. Operative time decreased over time for all three procedures (Figure 1). There were no conversions to open. Mean EBL was 33.2±37mL (0-250). Mean LOS was 2.18±1.83days (1-26). 90-day readmission rate was 6%. Overall morbidity rate was 5.8%. Mortality was zero. The RSG learning curve was shorter for Surgeon 2 with a comparable complication rate of 4% (Figure 1); Surgeon 2 did not perform enough RRYGB or ROAB cases to construct learning curves.
CONCLUSIONS: RSG, RRYGB, and ROAB operative time consistently and rapidly decreased while morbidity and readmission rates remained low, suggesting that the learning curve for robotic bariatric surgery is quick without compromising patient safety or increased morbidity.
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Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95157
Program Number: P158
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster