Robotic-Assisted Roux-en-Y Gastric Bypass: Learning Curve Assessment Using Cumulative Sum and Literature Review.

Area of Science:

• Minimally Invasive Surgery
• Bariatric Surgery
• Robotic Surgery

Background:

• Robotic-assisted Roux-en-Y gastric bypass (RARYGB) is increasingly utilized in the United States.
• The robotic platform is well-suited for RARYGB due to its capacity for hand-sewn suturing and energy device application.
• Centers of Excellence recognized by the American Society for Metabolic and Bariatric Surgery (ASMBS) are evaluating this approach.

Purpose of the Study:

• To review the literature on the robotic approach to RARYGB.
• To analyze the learning curve of RARYGB using the cumulative sum (CUSUM) method.
• To present the experience of a Center of Excellence in performing RARYGB.

Main Methods:

• Literature review of robotic RARYGB procedures.
• Inclusion of 67 patients in the study cohort.
• Application of the cumulative sum (CUSUM) method to assess the learning curve.

Main Results:

• The learning curve for RARYGB was determined to be achieved after the 11th case.
• A pooled analysis included data from eighteen studies.
• Operative time increased at case 46, indicating a second phase, with differences primarily related to prior bariatric surgery.

Conclusions:

• The robotic platform is expanding its role in complex procedures like RARYGB.
• The hand-sewn technique in robotic RARYGB may lead to a shorter learning curve.
• Potential benefits include reduced conversion rates and lower leakage rates.