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First Assistant In Bariatric Surgery: A Comparison Between Laparoscopic And Robotic Approaches: A 4-Year Analysis of
Ahmad Omid Rahimi1, Chiu-Hsieh Hsu2, Felipe Maegawa3
1Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, 1501N. Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA.
Obesity Surgery
|December 19, 2023
Summary
The robotic approach in bariatric surgery showed less operative time variation compared to laparoscopy, regardless of the first assistant (FA). Robotic surgery may reduce the need for skilled FAs in these procedures.
Area of Science:
- Bariatric surgery outcomes
- Minimally invasive surgical techniques
- Operating room efficiency
Background:
- The first assistant (FA) is crucial in bariatric surgery.
- Understanding the impact of FA and surgical approach on outcomes is important.
Purpose of the Study:
- To investigate the association between the type of first assistant (FA) and operative time (OT).
- To compare robotic versus laparoscopic approaches in bariatric surgery regarding OT and postoperative outcomes.
Main Methods:
- Analysis of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data (2016-2019).
- Log-normal and logistic regression models were used to assess FA impact on OT and 30-day outcomes.
- Comparison of robotic (R) and laparoscopic (L) sleeve gastrectomy (SG), Roux-en-Y gastric-bypass (RYGB), and duodenal switch (DS).
Main Results:
- Operative time variation was higher in the laparoscopic group (SG: 8.18%, RYGB: 9.88%, DS: 15.00%) than in the robotic group (SG: 2.43%, RYGB: 5.76%, DS: 0.80%).
- No significant difference in 30-day postoperative outcomes was observed between laparoscopic and robotic approaches for the same procedures.
- The first assistant was associated with decreased operative time variability in the robotic cohort compared to the laparoscopic group.
Conclusions:
- Robotic bariatric surgery demonstrated reduced operative time variability compared to laparoscopic approaches.
- The need for highly skilled first assistants may be lessened with robotic bariatric surgery.
- Complication rates were not significantly different between the two approaches, suggesting safety equivalence.
