Background

Robotic adoption in bariatric surgery continues to increase, with ergonomic benefits to the surgeon especially when operating on patients with severe obesity. However, the risks of robotic-assisted surgery for patients with severe obesity and as robotic adoption has increased have not been well-studied.

Methods

We analyzed MBSAQIP data from 2015 to 2021, including 1,082,565 patients undergoing initial laparoscopic vs. robotic-assisted Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) surgery. Subgroup analysis was performed for patients with severe obesity (BMI ≥ 50) and by surgical approach. Multivariate logistic regressions controlling for patient demographics, ASA class, BMI, comorbidities, and operative length were performed. Two-tailed t-tests were used to compare robotic-assisted surgery and complication rates between groups (α = 0.05).

Results

Rates of robotic-assisted RYGB/SG surgery increased significantly from 2015 to 2021, from 6.4% (2015) to 23.3% (2021, p < 0.05). Aggregate serious complication rates for robotic-assisted surgery decreased from 3.67% in 2015 to 2.56% (p < 0.01) in 2021, with greater reduction in complications for patients with severe obesity (2.65% in 2021 vs 4.74% in 2015, p < 0.01). Nevertheless, robotic assistance remains associated with increased risk for serious complications (OR = 1.041, p < 0.05). which appears to be mediated by increased length of robotic surgery (OR = 0.932, p < 0.01) when operative length is included as a confounder.

Conclusions

Serious complications in robotic-assisted bariatric surgery have decreased for patients with severe obesity over time, though robotic assistance is associated with higher risk than laparoscopy.