Mohammad A Farukhi, MD, Brian Davis, MD. Texas Tech University HSC El Paso
BACKGROUND: Obesity plays an important role in the preoperative evaluation when considering the optimal surgical approach for a patient. Obese patients generally have longer operative times, are technically more challenging and are at a higher risk of complications. However, robotic surgery excels over traditional laparoscopic surgery in dexterity and visualization and may be advantageous in this population. Our objective is to compare the feasibility and outcomes of the robot cholecystectomy (RC) vs traditional laparoscopic cholecystectomy (LC) in the morbidly obese patients.
Methods: This is a case control study of 139 patients who underwent robotic and laparoscopic cholecystectomy from 2014-2016 at an academic non-bariatric teaching hospital. We evaluated BMI, type of biliary disease, operative time, length of stay and intraoperative/postoperative complications. We used a BMI >35 as a cutoff for morbidly obese. Regression analysis was utilized to associate factors that affect operative time.
RESULTS: Out of the 139 patients, 69 (49.6%) were performed robotically and 70 (50.4%) were done laparoscopically. 42 patients with RC and 19 patients with LC were considered morbidly obese. The RC group had an operative time of 32.8 minutes longer than the LC counterpart in patients with BMI>35 (p=0.001) and 13.7 minutes longer than LC group in patients with BMI <35 (p=0.044). Obesity increased operative time on the robot by over 20.1 minutes (p=0.025) while minimally increasing the duration of laparoscopic cases by 1 minute (p=0.885). Multiple regression models confirmed that RC increases operative time among both BMI groups and when accounting for age (p=0.003) and similar biliary disease (p=0.064). There were no significant differences in postoperative outcomes or complications between the RC and LC groups.
CONCLUSION: The robot has a perceived advantage in overcoming technical challenges of abdominal surgery in the morbidly obese. We found that while the safety and outcomes of the robotic approach are similar to laparoscopy, the operative duration is significantly longer for the robot. Further studies will need to account for time utilized in robot docking and cholangiography to better demonstrate the robot’s efficacy and role in gallbladder surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80544
Program Number: P683
Presentation Session: Poster (Non CME)
Presentation Type: Poster
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