Savannah Bailey1, Timothy Kuwada2, Keith Gersin2, Connie Simms2, Dimitrios Stefanidis3. 1University of South Carolina, 2Carolinas Healthcare System, 3Indiana University
Background: Robotic technology leads to improved visualization and precision over laparoscopy but also higher cost of care. The benefits of this technology to patient outcomes are controversial. Our objective was to assess whether the application of robotic surgery to Roux-en-Y gastric bypass (RYGB) would lead to improved patient outcomes.
Methods: A prospectively collected database at a bariatric center of excellence was reviewed for all RYGB procedures performed by one surgeon between 2007-2015. Procedures performed laparoscopically (transoral circular stapling technique) versus robotically (hand sewn anastomosis) were compared; the transition in technique occurred in 2011. Patient demographics, baseline weight, BMI, operation duration, estimated blood loss (EBL), length of hospital stay (LOS), morbidity and mortality, and percent excess weight loss (%EWL) at 1 year follow-up, were compared between groups. Morbidity up to 1 year postop was assessed using the Clavien-Dindo classification.
Results: Of 246 patients, 125 underwent robotic and 121 laparoscopic RYGB. Patients in the robotic group were older and heavier but achieved similar %EWL to the laparoscopic group. The operative duration was longer but the mean patient LOS was shorter with the robotic approach. There were no leaks and no mortality. Based on the Clavien-Dindo classification fewer overall and fewer severe complications occurred in the robotic compared with the laparoscopic approach (Table 1).
| Robotic n=125 | Laparoscopic n=121 | p-value | |
| Age (years) | 45.6±11 | 42.2±10 | <0.01 |
| Baseline BMI | 48.3±7 | 46.7±5.5 | <0.05 |
| OR duration (minutes) | 213±65 | 154±42 | <0.001 |
| EBL (ml) | 48±31 | 54±43 | n.s. |
| LOS (days) | 1.7±0.7 | 2.1±1.0 | <0.001 |
| %EWL at 1 year | 84.2±45.5 | 76.7±53.1 | n.s. |
| Clavien-Dindo all grades (30 days) | 12% | 20% | 0.09 |
| Clavien-Dindo all grades (1 year) | 25.6% | 39.6% | 0.02 |
| Clavien-Dindo grades I&II | 4.8% | 6.6% | n.s. |
| Clavien-Dindo grades III&IV | 20.8% | 33% | 0.03 |
Conclusion: In our experience, the use of robotic technology for the creation of gastric bypass led to longer operative times and similar %EWL but decreased LOS and number and severity of complications compared with the laparoscopic approach. These benefits need further investigation in a controlled trial and may justify the increased cost of this technology.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79463
Program Number: S068
Presentation Session: Robotics
Presentation Type: Podium