Comparative analysis of robotic versus laparoscopic Roux-en-Y gastric bypass in severely obese patients

Abstract

Benefits of robotic surgery for Roux-en-Y gastric bypass (RYGB) are still debated. We aimed to compare conventional laparoscopic (L-RYGB) to robotic RYGB (R-RYGB) and evaluate safety, efficacy, advantages and drawbacks of each procedure. A prospective cohort study with a retrospective review approach was conducted to analyze results of L-RYGB and R-RYGB performed at a bariatric center of excellence. Patient demographics, perioperative data, weight loss, comorbidities evolution and cost were assessed. One hundred and sixty-one severely obese patients underwent R-RYGB and L-RYGB, respectively. Patient’s characteristics were similar between groups. Intraoperative blood loss was similar (p = 0.91), with no requirement for blood transfusion. Median operative time was significantly reduced for R-RYGB (127 vs 160 min; p < 0.001). Seven patients (11.4%) in the L-RYGB group and 15 patients (15%) in the R-RYGB group had early postoperative complications (p = 0.63), with more anastomotic leaks and stenosis for R-RYGB during initial learning curve (p = NS). Mortality was null. Median length of hospital stay was similar (6 days; p = 0.20). Mean hospital cost was non-significantly increased for R-RYGB ($5730 vs. $4879; p = 0.34). Two years after surgery, median BMI and mean EWL% were similar for both groups (26.1 vs 26.5 kg/m2 and 89.9% vs 90.9% for L-RYGB and R-RYGB groups, respectively; p = 0.71 and 0.85, respectively), with no statistically significant difference in comorbidities between the two groups (p = 0.80). R-RYGB is feasible and safe within the reach of every laparoscopic surgeon. In our series, it was associated with shorter operative time and equivalent length of stay and weight loss outcomes compared to L-RYGB. Further well-designed randomized studies are necessary to draw safe conclusions.

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Availability of data and material

The datasets of the current study can be provided by the corresponding author on reasonable request.

References

  1. 1.

    Chobot A, Gorowska-Kowolik K, Sokolowska M, Jarosz-Chobot P (2018) Obesity and diabetes-Not only a simple link between two epidemics. Diabetes Metab Res Rev 34:e3042

    Article  Google Scholar 

  2. 2.

    Zhang C, Zhang J, Liu Z, Zhou Z (2018) More than an anti-diabetic bariatric surgery, metabolic surgery alleviates systemic and local inflammation in obesity. Obes Surg 28:3658–3668

    Article  Google Scholar 

  3. 3.

    Gagner M, Hutchinson C, Rosenthal R (2016) Fifth international consensus conference: current status of sleeve gastrectomy. Surg Obes Relat Dis 12:750–756

    Article  Google Scholar 

  4. 4.

    American Society of Metabolic and Bariatric Surgery (2018) Estimate of Bariatric Surgery Numbers, 2011–2018. https://asmbs.org/resources/estimateof-bariatric-surgery-numbers

  5. 5.

    Lee JH, Nguyen QN, Le QA (2016) Comparative effectiveness of 3 bariatric surgery procedures: Roux-en-Y gastric bypass, laparoscopic adjustable gastric band, and sleeve gastrectomy. Surg Obes Relat Dis 12:997–1002

    Article  Google Scholar 

  6. 6.

    Ignat M, Vix M, Imad I, D’Urso A, Perretta S, Marescaux J, Mutter D (2017) Randomized trial of Roux-en-Y gastric bypass versus sleeve gastrectomy in achieving excess weight loss. Br J Surg 104:248–256

    CAS  Article  Google Scholar 

  7. 7.

    Arterburn D, Wellman R, Emiliano A, Smith SR, Odegaard AO, Murali S, Williams N, Coleman KJ, Courcoulas A, Coley RY, Anau J, Pardee R, Toh S, Janning C, Cook A, Sturtevant J, Horgan C, McTigue KM, PCBS Collaborative (2018) Comparative effectiveness and safety of bariatric procedures for weight loss: a PCORnet cohort study. Ann Intern Med 169:741–750

    Article  Google Scholar 

  8. 8.

    Robert M, Espalieu P, Pelascini E, Caiazzo R, Sterkers A, Khamphommala L, Poghosyan T, Chevallier JM, Malherbe V, Chouillard E, Reche F, Torcivia A, Maucort-Boulch D, Bin-Dorel S, Langlois-Jacques C, Delaunay D, Pattou F, Disse E (2019) Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. Lancet 393:1299–1309

    Article  Google Scholar 

  9. 9.

    Nguyen NT, Varela JE (2017) Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol 14:160–169

    Article  Google Scholar 

  10. 10.

    Lundberg PW, Wolfe S, Seaone J, Stoltzfus J, Claros L, El Chaar M (2018) Robotic gastric bypass is getting better: first results from the metabolic and bariatric surgery accreditation and quality improvement program. Surg Obes Relat Dis 14:1240–1245

    Article  Google Scholar 

  11. 11.

    Aiolfi A, Tornese S, Bonitta G, Rausa E, Micheletto G, Bona D (2019) Roux-en-Y gastric bypass: systematic review and Bayesian network meta-analysis comparing open, laparoscopic, and robotic approach. Surg Obes Relat Dis 15:985–994

    Article  Google Scholar 

  12. 12.

    Scozzari G, Rebecchi F, Millo P, Rocchietto S, Allieta R, Morino M (2011) Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass. Surg Endosc 25:597–603

    Article  Google Scholar 

  13. 13.

    Buchs NC, Morel P, Azagury DE, Jung M, Chassot G, Huber O, Hagen ME, Pugin F (2014) Laparoscopic versus robotic Roux-en-Y gastric bypass: lessons and long-term follow-up learned from a large prospective monocentric study. Obes Surg 24:2031–2039

    Article  Google Scholar 

  14. 14.

    Smeenk RM, van’t Hof G, Elsten E, Feskens PG (2016) The results of 100 robotic versus 100 laparoscopic gastric bypass procedures: a single high volume centre experience. Obes Surg 26:1266–1273

    CAS  Article  Google Scholar 

  15. 15.

    Rogula T, Koprivanac M, Janik MR, Petrosky JA, Nowacki AS, Dombrowska A, Kroh M, Brethauer S, Aminian A, Schauer P (2018) Does robotic Roux-en-Y gastric bypass provide outcome advantages over standard laparoscopic approaches? Obes Surg 28:2589–2596

    Article  Google Scholar 

  16. 16.

    Celio AC, Kasten KR, Schwoerer A, Pories WJ, Spaniolas K (2017) Perioperative safety of laparoscopic versus robotic gastric bypass: a propensity matched analysis of early experience. Surg Obes Relat Dis 13:1847–1852

    Article  Google Scholar 

  17. 17.

    Haute Autorité de Santé (2009) Obésité: prise en charge chirurgicale chez l'adulte. Saint Denis (France). HAS 1–263

  18. 18.

    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  19. 19.

    Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J, Buchwald H, Scopinaro N (2018) IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg 28:3783–3794

    Article  Google Scholar 

  20. 20.

    Beckmann JH, Bernsmeier A, Kersebaum JN, Mehdorn AS, von Schonfels W, Taivankhuu T, Laudes M, Schafmayer C, Egberts JH, Becker T (2020) The impact of robotics in learning Roux-en-Y gastric bypass: a retrospective analysis of 214 laparoscopic and robotic procedures: robotic vs laparoscopic RYGB. Obes Surg 30:2403–2410

    Article  Google Scholar 

  21. 21.

    Li K, Zou J, Tang J, Di J, Han X, Zhang P (2016) Robotic versus laparoscopic bariatric surgery: a systematic review and meta-analysis. Obes Surg 26:3031–3044

    Article  Google Scholar 

  22. 22.

    Economopoulos KP, Theocharidis V, McKenzie TJ, Sergentanis TN, Psaltopoulou T (2015) Robotic vs. laparoscopic Roux-En-Y gastric bypass: a systematic review and meta-analysis. Obes Surg 25:2180–2189

    Article  Google Scholar 

  23. 23.

    Ahmad A, Carleton JD, Ahmad ZF, Agarwala A (2016) Laparoscopic versus robotic-assisted Roux-en-Y gastric bypass: a retrospective, single-center study of early perioperative outcomes at a community hospital. Surg Endosc 30:3792–3796

    Article  Google Scholar 

  24. 24.

    Stefanidis D, Bailey SB, Kuwada T, Simms C, Gersin K (2018) Robotic gastric bypass may lead to fewer complications compared with laparoscopy. Surg Endosc 32:610–616

    Article  Google Scholar 

  25. 25.

    Senellart P, Saint-Jalmes G, Mfam WS, Abou-Mrad A (2020) Laparoscopic versus full robotic Roux-en-Y gastric bypass: retrospective, single-center study of the feasibility and short-term results. J Robot Surg 14:291–296

    Article  Google Scholar 

  26. 26.

    Sharma G, Strong AT, Tu C, Brethauer SA, Schauer PR, Aminian A (2018) Robotic platform for gastric bypass is associated with more resource utilization: an analysis of MBSAQIP dataset. Surg Obes Relat Dis 14:304–310

    Article  Google Scholar 

  27. 27.

    Moon RC, Gutierrez JC, Royall NA, Teixeira AF, Jawad MA (2016) Robotic Roux-en-Y gastric bypass, is it safer than laparoscopic bypass? Obes Surg 26:1016–1020

    Article  Google Scholar 

  28. 28.

    Yu SC, Clapp BL, Lee MJ, Albrecht WC, Scarborough TK, Wilson EB (2006) Robotic assistance provides excellent outcomes during the learning curve for laparoscopic Roux-en-Y gastric bypass: results from 100 robotic-assisted gastric bypasses. Am J Surg 192:746–749

    Article  Google Scholar 

  29. 29.

    Buchs NC, Pugin F, Bucher P, Hagen ME, Chassot G, Koutny-Fong P, Morel P (2012) Learning curve for robot-assisted Roux-en-Y gastric bypass. Surg Endosc 26:1116–1121

    Article  Google Scholar 

  30. 30.

    Benizri EI, Renaud M, Reibel N, Germain A, Ziegler O, Zarnegar R, Ayav A, Bresler L, Brunaud L (2013) Perioperative outcomes after totally robotic gastric bypass: a prospective nonrandomized controlled study. Am J Surg 206:145–151

    Article  Google Scholar 

  31. 31.

    Lyn-Sue JR, Winder JS, Kotch S, Colello J, Docimo S (2016) Laparoscopic gastric bypass to robotic gastric bypass: time and cost commitment involved in training and transitioning an academic surgical practice. J Robot Surg 10:111–115

    Article  Google Scholar 

  32. 32.

    Bailey JG, Hayden JA, Davis PJ, Liu RY, Haardt D, Ellsmere J (2014) Robotic versus laparoscopic Roux-en-Y gastric bypass (RYGB) in obese adults ages 18 to 65 years: a systematic review and economic analysis. Surg Endosc 28:414–426

    Article  Google Scholar 

  33. 33.

    Hagen ME, Rohner P, Jung MK, Amirghasemi N, Buchs NC, Fakhro J, Buehler L, Morel P (2017) Robotic gastric bypass surgery in the Swiss Health Care System: analysis of hospital costs and reimbursement. Obes Surg 27:2099–2105

    Article  Google Scholar 

  34. 34.

    Horgan S, Vanuno D (2001) Robots in laparoscopic surgery. J Laparoendosc Adv Surg Tech A 11:415–419

    CAS  Article  Google Scholar 

  35. 35.

    Pastrana M, Stoltzfus J, Al-Mandini A, El-Chaar M (2020) Evolution of outcomes of robotic bariatric surgery: first report based on MBSAQIP database. Surg Obes Relat Dis 16:912–916

    Google Scholar 

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No funding was received for this study.

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Contributions

PL and IBA contributed to the study conception and design. Material preparation, data collection and analysis were performed by MB and TD. The first draft of the manuscript was written by PL, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Panagiotis Lainas.

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Panagiotis Lainas, Radwan Kassir, Marine Benois, Joseph Derienne, Tarek Debs, Maissa Safieddine, Jean Gugenheim, Ibrahim Dagher, and Imed Ben Amor declare to have no conflicts of interest or financial ties to disclose.

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Lainas, P., Kassir, R., Benois, M. et al. Comparative analysis of robotic versus laparoscopic Roux-en-Y gastric bypass in severely obese patients. J Robotic Surg (2021). https://doi.org/10.1007/s11701-020-01181-5

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Keywords

  • Obesity
  • Bariatric surgery
  • Roux-en-Y
  • Gastric bypass
  • Robotic
  • Laparoscopy