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. 2024 Jan 17;18(1):34.
doi: 10.1007/s11701-023-01748-y.

Robot-assisted vs laparoscopic bariatric procedures in super-obese patients: clinical and economic outcomes

Giuseppe Marincola #  1 , Priscilla Francesca Procopio #  1   2 , Francesco Pennestrì  3   4 , Pierpaolo Gallucci  1 , Nikolaos Voloudakis  1   2 , Luigi Ciccoritti  1 , Francesco Greco  1 , Giulia Salvi  1   2 , Francesca Prioli  1 , Carmela De Crea  1   2 , Marco Raffaelli  1   2
Affiliations

Robot-assisted vs laparoscopic bariatric procedures in super-obese patients: clinical and economic outcomes

Giuseppe Marincola et al. J Robot Surg. .

Abstract

The increased operative time and costs represent the main limitations of robotic technology application to bariatric surgery. Robotic platforms may help the surgeon to overcome the technical difficulties in super-obese (SO, BMI ≥ 50 kg/m2) patients, in which multi-quadrant operations could be challenging. We aimed to evaluate the effect of robot-assisted (R) versus laparoscopic (L) approaches in Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) and Roux-en-Y Gastric Bypass (RYGB) in SO and Super-Super Obese (SSO, BMI ≥ 60 kg/m2) patients in terms of outcomes and cost-effectiveness. Bariatric procedures performed from 2012 to 2023 were retrospectively reviewed. The inclusion criteria were BMI ≥ 50 kg/m2, primary SADI-S or RYGB. Operative time (OT), early complications, post-operative stay (POS), overall costs and follow-up data were analyzed. A subgroup analysis for surgical procedures and SSO patients was also performed. Among 4596 patients, 174 RYGB and 91 SADI-S in BMI ≥ 50 kg/m2 patients were selected. After Propensity Score Matching analysis, two groups of patients were identified (laparoscopic and robot-assisted), each one composed of 18 RYGB and 26 SADI-S. Intraoperative and post-operative complication rates and POS were comparable. Mean OT was longer in robotic procedures compared with laparoscopy (199.1 ± 65.7 and 109.5 ± 39.1 min, respectively, p < 0.001). The difference in OT was eliminated after only SSO patients were included in the analysis (172.7 ± 24.1 vs 152.6 ± 26.2 min for R-SADI-S and L-SADI-S, respectively, p = 0.107). Robotic surgeries were associated with higher costs (8134.6 ± 1886.7 and 2386.7 ± 388.2 € in R-RYGB and L-RYGB, respectively; 7996.6 ± 873.1 and 3954.6 ± 631.1 € in R-SADI-S and L-SADI-S). Despite increased costs, robotic approach may represent an added value in more complex cases such as SSO patients.

Keywords: Cost analysis; Outcomes; Robot-assisted; Roux-en-Y Gastric Bypass (RYGB); Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S); Super-obese.

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Conflict of interest statement

Drs. Giuseppe Marincola, Priscilla Francesca Procopio, Francesco Pennestrì, Pierpaolo Gallucci, Nikolaos Voloudakis, Luigi Ciccoritti, Francesco Greco, Giulia Salvi, Francesca Prioli and Professors De Crea Carmela, Raffaelli Marco have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Study patient’s flowchart diagram
See this image and copyright information in PMC

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