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Benefits of total robotic metabolic and bariatric surgery over conventional laparoscopy

Two new studies presented at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2024 Annual Scientific Meeting suggest that total robotic metabolic and bariatric surgery may result in shorter operative times, reduced lengths of stay and lower complications, compared to laparoscopic approaches.

"The robotic platform has advantages for patients with diabetes and high surgical risk," said study co-author on both studies, Dr Cynthia Buffington, a researcher at AdventHealth. "Surgeons may achieve a higher level of precision, flexibility and control than is possible with conventional laparoscopy. This results in less tissue trauma, shorter recovery times, less opportunity for scarring, milder postoperative pain, and lower risk for infections and bleeds."

In the first study, ‘Improved Surgical Outcomes of Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG), and Duodenal Switch (DS) Performed Totally Robotic Versus Laparoscopic’, researchers from AdventHealth in Celebration, FL, examined the outcomes of a single surgeon who performed 809 metabolic and bariatric operations - 498 totally robotic and 311 laparoscopic - between 2020 and 2023.

They found that total robotic Roux-en-Y gastric bypass (RYGB) resulted in significantly shorter operative times (97.6min. vs. 115.4min), reduced hospitalisation (1.19 days vs. 1.39 days) and lower complication rates (1.7% vs. 5.1%), compared to conventional laparoscopy.

Total robotic sleeve gastrectomy procedures produced similar benefits - less operative time (47.4min. vs. 53.1min.), shorter length of stay (1.14 days vs. 1.30 days) and fewer complications (0.8% vs. 3.2%). The surgical approach to a duodenal switch did not influence operative times and complication rates, but the total robotic approach did result in shorter lengths of stay.

This study comes after recent meta-analyses and registry reports found that metabolic and bariatric surgery performed robotically had similar outcomes to conventional laparoscopy but with longer operative times and higher costs. The researchers note, however, that most of the robotic surgeries in these reports were robot-assisted rather than totally robotic.

In the second study, ‘The Advantages of Totally Robotic (TR) Metabolic Bariatric Surgery (MBS) on Surgical Outcomes of Patients with Type 2 Diabetes’, these same researchers report improved outcomes and efficiencies for robotic procedures involving patients, this time with severe obesity and type 2 diabetes. A total of 744 patients received either totally robotic (n=469) or laparoscopic RYGB or sleeve gastrectomy (n=275). Major complication rates for patients with diabetes (2.4% vs. 8.3%), length of stay (1.19 days vs. 1.48 days) and operative times (71.7 min. vs. 90.5 min.) were all lower compared to laparoscopy, and were comparable to rates seen with patients with no diabetes. The average preoperative BMI was 46.1.

"Total robotic surgery is playing an increasing role in metabolic and bariatric surgery bringing new efficiencies and fewer complications for certain procedures and patients," said Dr Ann Rogers, ASMBS President-elect and Director, Penn State Surgical Weight Loss Program, Penn State Health, Hershey, PA, who was not involved in the study.


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