Background

Revisional bariatric surgery (RBS) is becoming more frequent and is associated with higher operative risks. Whether robotic assistance confers any benefit in RBS is unclear. We aimed to compare the outcomes of robotic RBS vs. laparoscopic RBS.

Methods

The outcomes of patients from an academic MBSAQIP center of excellence who underwent RBS from 2018 to 2020 and had 1-year follow-up were reviewed. The robotic and laparoscopic RBS outcomes were compared using univariate and multivariate linear and logistic regression models as appropriate.

Results

116 elective cases (32.8% robotic RBS vs. 67.2% laparoscopic RBS) were included, with 93.1% of patients being female and 52.4±12.1 years old. The procedure duration was significantly longer in the robotic vs. laparoscopic RBS group (247.1±77.7 vs. 197.5±54.2; p<0.001). However, the 30-day emergency department (ED) visit rate and the number of visits were fewer in robotic RBS (7.9% vs. 26.9%, p=0.019 and 0.1±0.4 vs. 0.3±0.6; p=0.023, respectively) and hospital stay shorter (2.2±1.9 vs. 3.2±3.6; p=0.093; Table 1) compared to laparoscopic RBS. No significant differences were detected in readmissions, reoperations, reinterventions, intra- and post-operative occurrences, total weight loss, albumin and hematocrit change, glycosylated hemoglobin, and comorbidity resolution during follow-up (Table 1).

Conclusions

Robotic RBS was associated with increased procedure duration but lower 30-day ED visit rates and a trend toward decreased hospital stay compared to laparoscopic RBS. Our study findings suggest that there may be outcome benefits to using robotic assistance in revisional bariatric surgery. Randomized clinical trials are needed to better elucidate our findings.