Review of robotics in foregut and bariatric surgery

Abstract

Background: In the last decade, the robotic platform has been used in different surgical fields. However, the field of foregut and bariatric surgery is still evolving. Most surgeons still prefer laparoscopic techniques because it has proven clinical benefits, does not require complex setups, and does not have high costs compared with that of robotics. The aim of this article is to review the outcomes of foregut and bariatric surgery and its potential clinical advantages.

Methods: We performed a search on PUBMED for the most relevant articles published in the field of robotic bariatric and foregut surgery in the last 15 years. More than 40 articles were selected and included on this review. Several systematic reviews were also included. Very few randomized clinical trials are available.

Results: For the most part, robotic procedures were associated with better ergonomics for the surgeon, better visualization of the anatomy, easier fine dissection (i.e., lymphadenectomy) when required, and higher costs. In foregut surgery, the robotic system is associated with a significant lower rate of mucosal perforation in Heller myotomy compared to laparoscopy. In bariatric surgery, the clinical advantages have not been well documented yet; however, it seems robotics shortens the learning curve of Roux-en-Y gastric bypass (RYGB).

Conclusion: Foregut and bariatric robotic surgery is a surgical field still in development. For the vast majority of the procedures in this area, the clinical outcomes of robotic surgery are the same of standard laparoscopy. However, the use of robots in selected cases may have specific advantages and may overcome the limitations of laparoscopic surgery. More research is needed, especially large and well-designed randomized clinical trials, to elucidate more accurate conclusions.