Does Robotic Roux-en-Y Gastric Bypass Provide Outcome Advantages over Standard Laparoscopic Approaches?

Area of Science:

• Bariatric surgery
• Minimally invasive surgery
• Surgical technology

Background:

• The clinical benefits of robotic-assisted bariatric surgery over traditional laparoscopic approaches remain unclear.
• Direct comparative outcome studies between totally robotic Roux-en-Y gastric bypass (TRRYGB) and various laparoscopic Roux-en-Y gastric bypass (LRYGB) techniques are lacking.

Purpose of the Study:

• To compare the clinical outcomes of patients undergoing TRRYGB with those treated using different LRYGB techniques.
• To evaluate the efficacy and safety of robotic versus laparoscopic approaches in Roux-en-Y gastric bypass surgery.

Main Methods:

• A retrospective analysis of 578 obese patients who underwent RYGB between 2011 and 2014.
• Comparison of TRRYGB outcomes against three LRYGB techniques: 21-mm EEA circular-stapled gastrojejunal anastomosis (LRYGB-21CS), linear-stapled GJA (LRYGB-LS), and hand-sewn GJA (LRYGB-HS).
• Utilized multivariable analysis and propensity matching for robust outcome comparison.

Main Results:

• TRRYGB had a significantly longer operative time compared to all LRYGB groups.
• TRRYGB demonstrated a lower gastrojejunal anastomosis (GJA) stricture rate (2% vs. 17%, P=0.003), shorter hospital stay (2.6 vs. 4.3 days, P=0.008), and reduced readmission rate (12% vs. 28%, P=0.009) compared to LRYGB-21CS.
• No significant differences in clinical outcomes were observed between TRRYGB and LRYGB-LS or LRYGB-HS.

Conclusions:

• While TRRYGB increases operative time, it offers significant advantages over the LRYGB-21CS technique, including reduced stricture formation, shorter hospital stays, and lower readmission rates.
• TRRYGB does not provide demonstrable clinical benefits compared to LRYGB-LS and LRYGB-HS techniques, suggesting patient selection and surgeon preference may guide technique choice.