Robotic Roux en Y gastric bypass can be safe and cost-effective in a rural setting: clinical outcomes from a community hospital bariatric program

Abstract

Robotic Roux en Y gastric bypass (R-RYGB) is becoming more common due to the shifting trend toward robotic gastrointestinal surgery. The goal of this study is to determine if R-RYGB can be safely implemented at a robotic bariatric surgery program in a community hospital with similar results to laparoscopic RYGB (L-RYGB) in a cost-effective manner. A total of 50 R-RYGB procedures were performed with the Xi and the X da Vinci systems and compared with 50 L-RYGB cases by a single surgeon from October 2018 to January 2020 at an acute-care community hospital in a rural setting with a high-volume MBSAQIP-accredited program. A retrospective chart review was conducted with IRB approval and statistical analysis of 30-day morbidity, mortality, re-interventions, and resolution of co-morbidities, with financial analysis of cost reduction. Both groups were similar in age, gender, ASA class, co-morbidities, and body mass index (BMI). There was no mortality or anastomotic leak. The 30-day morbidity for R-RYGB was 10.0% with a re-operation rate of 4.0%. There were no conversions to open, and the mean hospital length of stay was 2.22 ± 1.19 days. There were no statistically significant differences between R-RYGB and L-RYGB with respect to any measured outcome, including intraoperative time (121.94 vs. 113.52, respectively; p = 0.1495). However, when incidences and percentages were used, R-RYGB had improved performance for most of the outcomes measuring safety. There was an average cost reduction of $816.90 per case (total saving of $40,845.00 for 50 cases) in the R-RYGB by transitioning from a hybrid approach to a totally robotic approach. R-RYGB appears to be as safe as L-RYGB and can be performed in a rural community hospital while maintaining a low complication rate, achieving a high co-morbidity resolution rate, and saving costs with a totally robotic approach.

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Correspondence to Rodolfo J. Oviedo.

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Dr. Oviedo and Dr. Nayak have no conflicts of interests to report. Ms. Long and Ms. Yan have no conflicts of interests to report.

Consent statement

The retrospective chart review for all patients who belong to both cohorts in this study was approved by the Institutional Review Board at Winchester Medical Center in Winchester, VA, USA. The IRB committee approved the retrospective chart review and consented to its statistical analysis and the writing of this manuscript after ensuring that the patients’ confidential information was fully protected, per ethical standards.

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Oviedo, R.J., Nayak, T., Long, Z. et al. Robotic Roux en Y gastric bypass can be safe and cost-effective in a rural setting: clinical outcomes from a community hospital bariatric program. J Robotic Surg (2021). https://doi.org/10.1007/s11701-021-01193-9

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Keywords

  • Robotic
  • Bariatric surgery
  • Roux en Y gastric bypass
  • Community hospital
  • Rural
  • da Vinci