Background

The robotic approach has been more commonly utilized for bariatric procedures. The aim of this study is to identify the differences in outcomes between the laparoscopic and robotic approach in three common bariatric surgeries in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.

Methods

The data from the MBSAQIP were collected for patients who underwent sleeve gastrectomy (SG), duodenal switch (DS) and Roux-en-Y gastric bypass (RYGB) between 2015-2020. The post-operative outcomes including 30-day mortality and morbidity were analyzed. Separate log-binomial regression models were estimated for each procedure to quantify the unadjusted and adjusted risk for each 30-day outcome (unplanned reoperation, wound disruption, death) between robotic-assisted and laparoscopic approaches. Risk ratios are reported alongside 95% confidence intervals, with ratios >1 indicating greater risk for the robotic-assisted group.

Results

Our analysis included 983,446 surgeries, with SG comprising the majority (71%), followed by RYGB (28%) and DS (1%). Results demonstrated a 12% higher risk of unplanned reoperation for robotic-assisted RYGB (RR 1.12, CI 1.04 - 1.21; p = 0.003); although, rates of reoperation were low (2.7% vs 2.4%). There were no statistically significant between-approach differences in unplanned reoperation for SG and DS. There was no statistically significant difference in any other outcomes (see table).

Conclusions

Our results suggest that robotic-assisted approach has comparable outcomes after adjusting for demographic and clinical characteristics among the three common bariatric procedures. The decision in choosing any particular approach should be decided upon surgeon expertise and cost effectiveness for the healthcare institution.