Objective: Compare robotic versus laparoscopic roux-en-Y gastric bypass (RYGB) for the treatment of morbid obesity in a community hospital.
Introduction: Since receiving Food and Drug Administration approval in 2000, surgery utilizing a robot (da Vinci® Surgical System) has been successfully performed in numerous procedures including RYGB. However, despite the proven safety profile, reported lower complication rates, and technical benefits of robotic surgery, only a few of the over 200 robotic surgery centers in the United States have consistently applied this technology to RYGB. In addition, there are limited studies with relatively small sample sizes that have compared robotic vs. laparoscopic RYGB in the literature.
Methods: Through a retrospective analysis of a prospectively collected database, we compared outcomes and complication rates of robotic vs. laparoscopic RYGB in the treatment of morbid obesity. All patients who underwent robotic RYGB performed through the Comprehensive Weight Management Program of Queen’s Medical Center (Honolulu, HI) between December 2006 to July 2009 were compared to a matched cohort of patients who received laparoscopic RYGB during the same study period. Outcomes data included weight loss, operative times, and hospital length of stay. All complications encountered by both groups were reported.
Results: Eightypatients who underwent robotic RYGB were compared to 80 patients who received laparoscopic RYGB. Rate of weight loss and reduction in body mass index (BMI) over time were similar in both groups. There were no mortalities in either group. The robotic group experience a 12.5% complication rate. Robotic complications included post-operative anemia (2 patients), marginal ulcer (2 patients), anastomotic stricture (4 patients), and anastomotic leaks (2 patients). The laparoscopic group also experienced a 12.5% complication rate for a range of issues including wound infections (2 patients), anastomotic stricture/ulcer (2 patients), aspiration pneuomonia (1 patient), anastomotic leak (1 patient) requiring re-operation, small bowel obstruction (1 patient), etc. Hospital length of stay and operative times were similar in both groups, but there was a trend towards a shorter length of stay with robotic RYGB.
|female/male||age (range)||BMI (range)||Operative time||length of stay||complications|
|Robotic||59/21||44 (21-69)||46.4 (33-75)||174 minutes||2.9 days||12.5%|
|Laparoscopic||52/28||44 (20-64)||49 (35-87)||164 minutes||3.1 days||12.5%|
Conclusion: Robotic RYGB is a safe and effective procedure for the surgical treatment of morbid obesity, and this approach can be utilized effectively in a community hospital setting. Robotic RYGB resulted in the same overall complication rate as the laparoscopic approach with a trend towards a shorter length of stay. Operative times decreased after the initial few robotic RYGB, and this may be due to a more favorable learning curve for robotic RYGB. Future studies comparing actual cost comparisons and analysis of outcomes are needed.
Session: Podium Presentation
Program Number: S051