Robotic versus laparoscopic Roux-en-Y gastric bypass: Short and long term clinical outcomes and costs

Monika E Hagen, Minoa K Jung, Frederic Ris, Jassim Fakhro, Leo Buehler, Philippe Morel. University Hospital Geneva

Introduction: Previous studies indicate that robotics might result in better clinical outcomes and lower costs when compared to conventional laparoscopy. However, currently available studies do not analyze long-term treatments and their costs after gastric bypass surgery. We hypothesized that previously described potential long-term advantages of robotic gastric bypass such as a reduced rate of anastomotic strictures might also be reproducible in our patient population, resulting in fewer long-term procedures and reduced long-term costs when compared to conventional laparoscopy.  

Methods and Procedures: Prospectively collected clinical short- and long-term data (Peri-operative and up to 3 to 5 years) of patients who underwent gastric bypass surgery from 2006 to 2011 was analyzed. Cost data derived from an administrative high quality activity-based cost analysis was matched to the clinical information and short as well as long-term cost scenarios were modeled. Cost model considered detailed information regarding OR-costs, anesthesia, cost of care, medication, material, hostelry, salaries of staff, and others. Costs were derived from primary hospitalization as well as outpatient consultations and re-hospitalizations related to the primary procedure within 3 – 5 years from the gastric bypass surgery.

Results: 247 patients underwent robotic and 285 laparoscopic Roux-en-Y gastric bypass at our institution between 2006 and 2011. Both patient cohorts showed similar demographics in regards to age, gender distribution and pre-operative body mass index. With longer OR times (271.3 min vs. 237.4 min, p=0.001) and similar rate of intra-operative complications (1.2% vs. 1.4%, p=1), fewer conversions (0.4% vs. 2.8%, p=0.0418), fewer peri-operative complications (10.9% vs 18.1%, p=0.0201), fewer re-operations (0.8% vs. 3.2, p=0.071) and a shorter length of stay (6.4 vs. 10.2 days, p=0.0001) was observed for the robotic patients when compared to the laparoscopic cohort. Modeled peri-operative costs were significantly lower for the robotic cohort when compared to conventional laparoscopy (USD 19 882 vs. USD 22 216, p=0.0078). Robotic patients underwent fewer long-term re-intervention resulting in lower long-term costs when compared to the laparoscopic cohort.   

Conclusions: Robotic technology seems to improve short- and long-term clinical outcomes of Roux-en-Y gastric bypass surgery when compared to conventional laparoscopy. With both reduced cost peri- as well as short and long term postoperatively, robotic gastric bypass surgery appears to result in overall reduced costs in out setting. 

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