Laparoscopic versus full robotic Roux-en-Y gastric bypass: retrospective, single-center study of the feasibility and short-term results

Abstract

Robotic bariatric surgery is an alternative to laparoscopy. It gives the surgeon an accurate three-dimensional view, allowing complex maneuvers while maintaining full control of the theater. We report our experience with this innovative surgery compared with laparoscopy during Roux-en-Y gastric bypass, to demonstrate its safety and feasibility. Our single-center study retrospectively identified obese patients who underwent either laparoscopic or robot-assisted gastric bypass procedures over a 2-year period. Demographics, intraoperative outcomes, mortality and morbidity data were collected. Of the 343 gastric bypass procedures identified, 147 were laparoscopic and 196 robotic-assisted. There were significant differences in age and BMI, being younger and more obese in the robotic group (p = 0.001). The mean operative time was longer in the robotic group; the mean additional time was required for docking, otherwise, the surgical time between groups was comparable. Operative time decreased in line with increasing skills. The conversion rate to laparotomy was 1% (robotic group). Morbidity was generally lower in the robotic group compared with laparoscopy, (hemorrhages 2.5% vs. 6.8%, respectively; anastomotic fistulas 0.5% vs. 2.7%). Statistically, results seem to favor robotic assistance. No mortality was observed in either group. The mean hospital stay was significantly shorter in the robotic group (p = 0.007). Robotic gastric bypass is feasible and, within the reach of every laparoscopic surgeon. Its results are comparable to laparoscopy and surgery is facilitated in higher BMI patients. Randomized, prospective studies are necessary to support our results.

Keywords: Gastric bypass surgery; Laparoscopy; Obesity; Robot-assisted surgery.