Robotic outcomes comparable with laparoscopic bariatric surgery

The number of robotic MBS procedures in Australia has risen over the years but the proportion of surgeons performing them remain relatively small, according to an analysis from the Australia and New Zealand Bariatric Surgery Registry. When adjusted for cofounders, clinical outcomes of robotic BMS were comparable to laparoscopic BMS with no increased risks of defined adverse events or complications, researchers from Monash University, Melbourne, Australia.

The study was led by Professor Wendy Brown, head of Surgery - Alfred at Monash Translational Medicine, and PhD candidate, Yit Leang, who examined data from 66,000 procedures, of which 910 (1.4 per cent) were performed using robotic technology.

“Early on, there were concerns that robotic surgery might carry more risks,” explained Brown. “But when we adjusted for things like the type of surgery and patient health, the outcomes between robotic and laparoscopic surgery were actually very similar. These were not simple cases. Robotic surgery was more often used for bypasses and revision procedures, which are naturally more complex and carry higher risks.”

Primary outcomes included 90-day post operative mortality related to the bariatric surgery, return to theatre, unplanned admission to intensive care unit, readmission to hospital and procedure specific complications. Secondary outcome was intra operative organ injury or perforation.

The number of robotic cases performed per year was less than 30 from 2014-2018, rising to 188 cases in 2019. After a flattening out of activity during the COVID pandemic, 288 cases were performed in 2021.

The number of robotic one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) has been proportionately higher than sleeve gastrectomy (SG) throughout the study period except for year 2019 and 2021. In contrast, within the laparoscopic group, SG was performed far more frequently (n=45,122) than laparoscopic OAGB and RYGB combined (n=15,287).

Overall, they reported that clinical outcomes in the pre-matching cohort demonstrated significant differences in unplanned return to theatre, unplanned ICU admission, unplanned readmission to hospital, total post operative complications in particular anastomotic leak favouring the laparoscopic cohort. Outcomes of the laparoscopic cases performed by robotic surgeons were comparable to overall laparoscopic cases recorded within the Registry.

After adjusting against confounding factors through propensity score matching, no significant differences in clinical outcomes between laparoscopic and robotic surgery were observed.

Although robotic surgery is gaining traction, it is still performed by a minority of bariatric surgeons in Australia. The study found that surgeons using robotic platforms were often early in their learning curve with this technology, yet outcomes were still comparable to traditional methods.

“This is reassuring. It demonstrates that, when used responsibly by skilled surgeons, robotic surgery does not increase the risk of adverse events. There’s been a lot of excitement about robotic platforms, and rightly so,” added Brown. “But we need to make sure we’re adopting these tools in a way that’s safe and evidence-based.”

To that end, the team has launched a new national, multi-centre trial to study how surgeons perform specific parts of the operation using robotic versus laparoscopic tools. Video analysis and technical scoring will be used to better understand subtle differences.

“The evidence supports the safe integration of robotic technology into bariatric surgical practice,” Brown concluded. “But this must be accompanied by continued evaluation, ethical oversight, and a commitment to high standards of care. We need structured training, strong credentialling ongoing monitoring and patient safety must always come first.”

The study, ‘Robotic bariatric surgery in Australia: early outcomes from a national clinical quality registry with propensity score matched analysis’, was published in the Journal of Robotic Surgery. To access this paper, please click here