Robotic approach does not eliminate first assistant in bariatric surgery compared to laparoscopy.

Area of Science:

• Bariatric Metabolic Surgery
• Minimally Invasive Surgical Technologies

Background:

• Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) are leading bariatric procedures.
• Robotic-assisted surgery use is limited by cost and operative time.
• The need for surgical first assistants (FAs) in robotic versus laparoscopic bariatric procedures requires investigation.

Purpose of the Study:

• To determine if robotic platforms reduce the requirement for a surgical first assistant.
• To compare the utilization of skilled surgical assistants between robotic and laparoscopic bariatric procedures.

Main Methods:

• Retrospective analysis of the MBSAQIP Participant Use File (2015-2019).
• Propensity score matching (SMD < 0.10) to compare attending surgeon and non-physician first assistant involvement.
• Exclusion of cases involving medical trainees.

Main Results:

• Robotic RYGB (RRYGB) showed a significant decrease in attending-level FAs (13.7%) compared to LRYGB (25.9%).
• Robotic SG (RSG) also showed a significant decrease in attending-level FAs (16.1%) compared to LSG (28.1%).
• Mid-level assistants were utilized in the majority of both robotic and laparoscopic procedures for both RYGB and SG.

Conclusions:

• Robotic platforms did not decrease the need for assistants in RYGB but did in SG.
• The robotic platform was associated with a ~12% reduction in attending-level assistance.
• Mid-level surgical assistants remain crucial for most robotic and laparoscopic bariatric cases.