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Robot-Assisted versus Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A Propensity Score-Matched Comparative Analysis of 118,313 cases using the 2015-MBSAQIP.

Raul Sebastian1, Melanie Howell2, Ambar Mehta2, Gina Adrales2, Alisa Coker2, Thomas Magnuson2, Michael Schweitzer2, Hien T Nguyen2. 1George Washington, 2Johns Hopkins

Introduction: Robotic-assisted bariatric surgeries are part of the armamentarium currently available in many bariatric centers. Limited data is available regarding the comparative effectiveness of robotic and laparoscopic approaches. This study compares 30-day outcomes between robotic-assisted and laparoscopic procedures for two bariatric surgeries: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

Methods: Using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, patients >18-60 years old were included. Demographic data, comorbidities, operative variables, and 30-day outcomes were compiled for patients undergoing RYGB and SG. To adjust for potential baseline confounders, 1:1 propensity-score matching (PSM) was performed using 18 comorbid conditions. Second PSM analysis was performed to adjust for operative time and conversion rate. Statistical analysis was performed before and after PSM.

Results: A total of 118,313 patients were selected: 81,960 patients underwent SG and 36,353 patients underwent RYGB After propensity score-matched analysis, Robotic Assisted Sleeve Gastrectomy (RSG) and Laparoscopic Sleeve Gastrectomy (LSG) cohorts evaluated 5,201 matched cases while Robotic Assisted Roux-en-Y Gastric Bypass (RRYGB) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) evaluated 2,552 matched cases.

Regardless of procedure performed, the operative time was significantly longer in the Robotic assisted cases (RSG 104+/-45 vs LSG 75+/-37, p<0.0001 and RRYGB 156+/-63 vs LRYGB 119+/-57, p<0.0001). However, In the RYGP cohort, the robotic approach showed significantly less requirements for blood transfusions (RRYGB 0.51% vs LRYGB 1.37%, P=0.002). The two methods were similar in the other evaluated 30-day outcomes. When analyzing the SG cases, reoperations (RSG 1.31% vs LSG 0.65%, p=0.001), need for additional interventions (IR drainage, UGI, endoscopy) (RSG 1.69% vs LSG 0.96% p=0.002) and conversion rate (RSG 0.71% vs LSG 0.10%, p<0.0001) were significantly higher in the Robotic group. Also, shorter hospital stay was associated with the laparoscopic approach (LSG 1.69+/-1.76 vs RSG 1.78+/-1.94 p<0.0001). Conversely, when adding operative time and conversion rate to the PSM analysis, the RRYGP group showed significantly shorter length of stay (RRYGB 2.17+/-2.18 vs LRYGB 2.29+/-2.66, p <0.001). In this second analysis, the significance in hospital duration disappeared within the SG group (RSG 1.78+/-1.94 vs LSG 1.84+/-2.25, p=0.13).

Conclusions: RRYGP is safe, and has similar outcomes to LRYGP in terms of perioperative complications, with significantly reduced blood transfusions with RRYGP.  Although operative time for robotic cases was longer, there was a strong correlation between shorter operative time and decreased hospital length of stay, especially in RRYGP.  


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87812

Program Number: S102

Presentation Session: Robotics 2 Session

Presentation Type: Podium

15

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