Elan R Witkowski, MD, MS, Julietta H Chang, MD, Matthew M Hutter, MD, MPH. Mass General Hospital / Harvard Medical School
Introduction: Minimally invasive techniques have greatly improved outcomes in bariatric surgery. Recently, robotic-assisted techniques have been increasingly adopted. Relatively little published data is available regarding the use, safety, and value of robotics in bariatric surgery at a population level. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) collects clinically-rich data for the majority of all bariatric operations performed in the United States. Trained collectors record data related to the surgical approach (including laparoscopic or robotic), as well as conversion to alternative approaches. We used the first Participant Use File (PUF) from the MBSAQIP to examine the current use and safety of robotic-assistance in bariatric surgery at a national level.
Methods: All patients who underwent primary elective bariatric operations were identified. Univariate statistics were compared between patients who received different approaches. To examine the effects of robotic-assistance more carefully, a subset of patients was selected who underwent the most common operations (sleeve gastrectomy or gastric bypass) via either robotic or conventional laparoscopic approach. Multivariable logistic regression was performed to determine the independent effect of robotic vs conventional laparoscopic approach on complications.
Results: 140,649 patients who underwent elective primary bariatric operations in 2015 were identified. Of those, the initial approach was laparoscopic for 124,169(88.28%), robotic-assisted for 8,773(6.24%), and “laparoscopic-assisted” for 6,413(4.56%). Few cases performed with hand assist, NOTES, or single-incision. Utilization of robotics was highest for BPD/DS(227 of 1,051 cases, 21.6%). The greatest number of robotic-assisted cases were sleeve gastrectomy(5,539 of 92,406, 5.99%) and gastric bypass(2,904 of 36,076 cases, 7.18%).
Relatively few operations were converted to a different approach (see table). Operative time was longer when using robotic approaches for both sleeve(74.01 vs 102.39 minutes, p<0.0001) and bypass(116.62 vs 152.68, p<0.0001). Postoperative LOS was no shorter when using robotic-assistance (see table). Unadjusted 30-day outcomes revealed slightly higher rates of readmission for both operations when using robotic-assistance (see table), and slightly higher rates of complications after robotic sleeve gastrectomy (3.91% vs. 3.06%, p<0.001). Multivariable modeling showed no significant impact of robotic-assistance vs conventional laparoscopy on major complications or death (OR 1.1, 95%CI 0.99-1.22).
Conclusions: Robotic-assisted bariatric surgery is being performed for over 6% of all cases. This analysis of the MBSAQIP data demonstrates that the rate of conversion to open surgery is low, and that robotic surgery is safe, though operative times are longer. The benefit over conventional laparoscopy cannot be seen in this data set.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88507
Program Number: P751
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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