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Read MD, Torikashvili J, Janjua H, Grimsley EA, Kuo PC, Docimo S. The downtrending cost of robotic bariatric surgery: a cost analysis of 47,788 bariatric patients. J Robot Surg 2024; 18:63. [PMID: 38308699 DOI: 10.1007/s11701-023-01809-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/23/2023] [Indexed: 02/05/2024]
Abstract
The surgical robot is assumed to be a fixed, indirect cost. We hypothesized rising volume of robotic bariatric procedures would decrease cost per patient over time. Patients who underwent elective, initial gastric bypass (GB) or sleeve gastrectomy (SG) for morbid obesity were selected from Florida Agency for Health Care Administration database from 2017 to 2021. Inflation-adjusted cost per patient was collected. Cost-over-time ($/patient year) and change in cost-over-time were calculated for open, laparoscopic, and robotic cases. Linear regression on cost generated predictive parameters. Density plots utilizing area under the curve demonstrated cost overlap. Among 76 hospitals, 11,472 bypasses (223 open, 6885 laparoscopic, 4364 robotic) and 36,316 sleeves (26,596 laparoscopic, 9724 robotic) were included. Total cost for robotic was approximately 1.5-fold higher (p < 0.001) than laparoscopic for both procedures. For GB, laparoscopic had lower total ($15,520) and operative ($6497) average cost compared to open (total $17,779; operative $9273) and robotic (total $21,756; operative $10,896). For SG, laparoscopic total cost was significantly less than robotic ($10,691 vs. $16,393). Robotic GB cost-over-time increased until 2021, when there was a large decrease in cost (-$944, compared with 2020). Robotic SG total cost-over time fluctuated, but decreased significantly in 2021 (-$490 compared with 2020). While surgical costs rose significantly in 2020 for bariatric procedures, our study suggests a possible downward trend in robotic bariatric surgery as total and operative costs are decreasing at a higher rate than laparoscopic costs.
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Affiliation(s)
- Meagan D Read
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Johnathan Torikashvili
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Haroon Janjua
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Emily A Grimsley
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Paul C Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA
| | - Salvatore Docimo
- Department of Surgery, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Rm 7015, Tampa, FL, 33606, USA.
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Velardi AM, Anoldo P, Nigro S, Navarra G. Advancements in Bariatric Surgery: A Comparative Review of Laparoscopic and Robotic Techniques. J Pers Med 2024; 14:151. [PMID: 38392584 PMCID: PMC10890254 DOI: 10.3390/jpm14020151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/24/2024] Open
Abstract
This article examines the evolution of bariatric surgery, with a focus on emerging technologies such as robotics and laparoscopy. In the case of gastric bypass, no significant differences have emerged between the two techniques in terms of hospitalization duration, weight loss, weight regain, or 30-day mortality. Robotic surgery, while requiring more time in the operating room, has been associated with lower rates of bleeding, mortality, transfusions, and infections. In revisional bariatric surgery, the robotic approach has shown fewer complications, shorter hospital stays, and a reduced need for conversion to open surgery. In the case of sleeve gastrectomy, robotic procedures have required more time and longer postoperative stays but have recorded lower rates of transfusions and bleeding compared to laparoscopy. However, robotic surgeries have proven to be more costly and potentially more complex in terms of postoperative complications. The review has also addressed the topic of the single-anastomosis duodeno-ileal switch (SADIS), finding comparable results between robotic and laparoscopic techniques, although robotic procedures have required more time in the operating room. Robotic technology has proven to be safe and effective, albeit with slightly longer operative times in some cases.
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Affiliation(s)
- Angelo Maria Velardi
- Oncologic Surgery, Department of Human Pathology of Adult and Evolutive Age, University of Messina, Via Consolare Valeria, 98125 Messina, Italy
| | - Pietro Anoldo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Stefania Nigro
- Oncologic Surgery, Department of Human Pathology of Adult and Evolutive Age, University of Messina, Via Consolare Valeria, 98125 Messina, Italy
| | - Giuseppe Navarra
- Oncologic Surgery, Department of Human Pathology of Adult and Evolutive Age, University of Messina, Via Consolare Valeria, 98125 Messina, Italy
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Leang YJ, Mayavel N, Yang WTW, Kong JCH, Hensman C, Burton PR, Brown WA. Robotic versus laparoscopic gastric bypass in bariatric surgery: a systematic review and meta-analysis on perioperative outcomes. Surg Obes Relat Dis 2024; 20:62-71. [PMID: 37730445 DOI: 10.1016/j.soard.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/22/2023] [Accepted: 08/05/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Robotic-assisted surgery has emerged as a compelling approach to bariatric surgery. However, current literature has not consistently demonstrated superior outcomes to laparoscopic bariatric surgery to justify its higher cost. With its mechanical advantages, the potential gains from the robotic surgical platform are likely to be apparent in more complex cases such as gastric bypass, especially revisional cases. OBJECTIVE This systematic review and meta-analysis aimed to summarize the literature and evaluate the peri-operative outcomes of patients with obesity undergoing robotic gastric bypass versus laparoscopic gastric bypass surgery. SETTING Systematic review. METHODS A literature search of Embase, Medline, Pubmed, Cochrane library, and Google Scholar was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing outcomes of robotic and laparoscopic gastric bypass for obesity were included. RESULTS Twenty-eight eligible studies comprised a total of 82,155 patients; 9051 robotic bypass surgery (RBS) versus 73,104 laparoscopic bypass surgery (LBS) were included. All included studies compared Roux-en-Y gastric bypass. RBS was noted to have higher reoperation rate within 30 days (4.4% versus 3.4%; odds ratio 1.31 [95% CI, 1.04-1.66]; P = .027; I2 = 43.5%) than LBS. All other endpoints measured (complication rate, anastomotic leak, anastomotic stricture, surgical site infections, hospital readmission, length of stay, operative time, conversion rate and mortality) did not show any difference between RBS and LBS. CONCLUSION This systematic review and meta-analysis showed that there was no significant difference in key outcome measures in robotic versus laparoscopic gastric bypass. RBS was associated with a slightly higher reoperation rate and there was no reduction in overall complication rate with the use of robotic platform.
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Affiliation(s)
- Yit J Leang
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia.
| | - Naveen Mayavel
- Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Wilson T W Yang
- Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Joseph C H Kong
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Chrys Hensman
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Paul R Burton
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Wendy A Brown
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
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Al-Mazrou AM, Bellorin O, Dhar V, Dakin G, Afaneh C. Selection of Robotic Bariatric Surgery Candidates: a Nationwide Analysis. J Gastrointest Surg 2023; 27:903-913. [PMID: 36737593 DOI: 10.1007/s11605-023-05595-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/07/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION This study aims to identify risk factors associated with 30-day major complications, readmission, and delayed discharge for patients undergoing robotic bariatric surgery. METHODS From the metabolic and bariatric surgery and accreditation quality improvement program (2015-2018) datasets, adult patients who underwent elective robotic bariatric operations were included. Predictors for 30-day major complications, readmission, and delayed discharge (hospital stay ≥ 3 days) were identified using univariable and multivariable analyses. RESULTS Major complications in patients undergoing robotic bariatric surgery were associated with both pre-operative and intraoperative factors including pre-existing cardiac morbidity (OR = 1.41, CI = [1.09-1.82]), gastroesophageal reflux disease [GERD] (OR = 1.23, CI = [1.11-1.38]), pulmonary embolism (OR = 1.51, CI = [1.02-2.22]), prior bariatric surgery (OR = 1.66, CI = [1.43-1.94]), increased operating time (OR = 1.003, CI = [1.002-1.004]), gastric bypass or duodenal switch (OR = 1.58, CI = [1.40-1.79]), and intraoperative drain placement (OR = 1.28, CI = [1.11-1.47]). With regard to 30-day readmission, non-white race (OR = 1.25, CI = [1.14-1.39]), preoperative hyperlipidemia (OR = 1.16, CI = [1.14-1.38]), DVT (OR = 1.48, CI = [1.10-1.99]), therapeutic anticoagulation (OR = 1.48, CI = [1.16-1.89]), limited ambulation (OR = 1.33, CI = [1.01-1.74]), and dialysis (OR = 2.14, CI = [1.13-4.09]) were significantly associated factors. Age ≥ 65 (OR = 1.18, CI = [1.04-1.34]), female gender (OR = 1.21, CI = [1.10-1.32]), hypertension (OR = 1.08, CI = [1.01-1.15]), renal insufficiency (OR = 2.32, CI = [1.69-3.17]), COPD (OR = 1.49, CI = [1.23-1.82]), sleep apnea (OR = 1.10, CI = [1.03-1.18]), oxygen dependence (OR = 1.47, CI = [1.10-2.0]), steroid use (OR = 1.26, CI = [1.02-1.55]), IVC filter (OR = 1.52, CI = [1.15-2.0]), and BMI ≥ 40 (OR = 1.12, CI = [1.04-1.21]) were risk factors associated with delayed discharge. CONCLUSION When selecting patients for bariatric surgery, surgeons early in their learning curve for utilizing robotics should avoid individuals with pre-existing cardiac or renal morbidities, venous thromboembolism, and limited functional status. Patients who have had previous bariatric surgery or require technically demanding operations are at higher risk for complications. An evidence-based approach in selecting bariatric candidates may potentially minimize the overall costs associated with adopting the technology.
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Affiliation(s)
- Ahmed M Al-Mazrou
- Division of GI Metabolic and Bariatric Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, 525 East 68Th Street Box 294, New York, NY, 10065, USA
| | - Omar Bellorin
- Division of GI Metabolic and Bariatric Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, 525 East 68Th Street Box 294, New York, NY, 10065, USA
| | - Vikrom Dhar
- Division of GI Metabolic and Bariatric Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, 525 East 68Th Street Box 294, New York, NY, 10065, USA
| | - Gregory Dakin
- Division of GI Metabolic and Bariatric Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, 525 East 68Th Street Box 294, New York, NY, 10065, USA
| | - Cheguevara Afaneh
- Division of GI Metabolic and Bariatric Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, 525 East 68Th Street Box 294, New York, NY, 10065, USA.
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Cost-Effectiveness of Totally Robotic and Conventional Laparoscopic Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis. Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2022.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Kauffels A, Reichert M, Askevold I, Bender A, Hecker A, Padberg W, Sprenger T. Establishing robotic bariatric surgery at an academic tertiary hospital: a learning curve analysis for totally robotic Roux-en-Y gastric bypass. J Robot Surg 2022; 17:577-585. [PMID: 35994194 PMCID: PMC10076403 DOI: 10.1007/s11701-022-01454-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/11/2022] [Indexed: 10/15/2022]
Abstract
The use of robotic systems in bariatric surgery has constantly increased over the last years. However, beside its technical advantages in morbidly obese patients the conclusive role of robotics in bariatric and metabolic surgery is still under controversial debate. This is an analysis of prospectively collected data of consecutive patients undergoing fully robotic Roux-en-Y gastric bypasses (TR-RYGB) during the first year after implementation of a robotic bariatric program at a tertiary university hospital. All patients were operated by a previously untrained robotic but experienced laparoscopic bariatric surgeon using the daVinci Xi system (Intuitive Surgical, Sarl). Data recording included patient characteristics, operative and functional outcomes, complications and learning curves for surgeon and assistants. In total, 80 patients underwent primary or revisional robotic bariatric surgery. Seventy-two patients (90%) received a TR-RYGB. There were no major complications, re-interventions or readmissions. The overall complication rate was 2.5% (Clavien-Dindo grade I and II). The overall operation time was 140.7 ± 24.6 min and decreased significantly from the first to the last decade of procedures (procedure 1-10: 171.2 ± 26.3 min versus procedure 63-72: 116.0 ± 10.9 min, p < 0.0001). A stabilization of the learning curve was observed after 30 procedures for the surgeon and after five procedures for the bedside assistant. With immediate effect, TR-RYGB is a safe procedure with low complication rates for an experienced laparoscopic bariatric surgeon without prior robotic skills. Learning curves are steep and operation times can be effectively decreased by increasing the experience of the surgeon.
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Affiliation(s)
- Anne Kauffels
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf- Buchheim-Str. 7, 35392, Giessen, Germany
| | - Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf- Buchheim-Str. 7, 35392, Giessen, Germany
| | - Ingolf Askevold
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf- Buchheim-Str. 7, 35392, Giessen, Germany
| | - Anna Bender
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf- Buchheim-Str. 7, 35392, Giessen, Germany
| | - Andreas Hecker
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf- Buchheim-Str. 7, 35392, Giessen, Germany
| | - Winfried Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf- Buchheim-Str. 7, 35392, Giessen, Germany
| | - Thilo Sprenger
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf- Buchheim-Str. 7, 35392, Giessen, Germany.
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Australian experience with robot-assisted Roux-en-Y gastric bypass with comparison to a conventional laparoscopic series. Surg Endosc 2022; 36:4025-4031. [PMID: 34524534 DOI: 10.1007/s00464-021-08723-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/30/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Robotic surgery is a novel approach to abdominal surgery. In Australia, the uptake of robotic assistance for bariatric surgery has been relatively slow compared to many other countries. The aim of this study is to report the first high volume experience of robotic-assisted Roux-en-Y gastric bypass surgery in Australia (RRYGB) and compare outcomes with a similar laparoscopic group (LRYGB). METHODS Retrospective analysis of 100 RRYGB versus 100 LRYGB was carried out over a period of seven years performed by two surgeons. These groups were matched by revisional status. Outcomes recorded included operative times, conversion rate, hospital stay, short-term (30 days) complication rates, and long-term complication rates. Baseline comorbidities of patients were also recorded. RESULTS Baseline characteristics of the two groups were similar except for comorbidity rates (higher in LRYGB group). The mean age was 43 (RRYGB) and 44(LRYGB) years, respectively. The mean pre-op BMI was 44.3 in the RRYGB group and 44.7 in the LRYGB group. Mean operating time in the RRYGB group was 208 min compared to 175 min in the LRYGB group. The number of patients with major complications was 1 in the robotic group versus 5 in the laparoscopic group (P: 0.2166). Minor complications were higher in the robotic group (17 vs. 5, P: 0.0054). Median length of stay of patients with RRYGB was 4 days compared to 5 days for the LRYGB group. CONCLUSION RRYGB has been successfully implemented in Australia with low complication rates compared to conventional laparoscopic RYGB. Operating times are longer compared to LRYGB which is consistent with most published literature. To justify increased costs generally associated with robotic surgery, better quality studies are needed to accurately assess potential cost savings with length of stay and safety benefits to patients and institutions.
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Bedirli A, Yavuz A, Dikmen K, Buyukkasap C, Ozaydin S. Robotic Roux-en-Y Gastric Bypass: A Single Surgeon's Experience with 527 Consecutive Patients. JSLS 2022; 26:JSLS.2021.00072. [PMID: 35444400 PMCID: PMC8993462 DOI: 10.4293/jsls.2021.00072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives Robotic bariatric surgery is increasingly adopted by surgeons. We present the surgical results of 527 consecutive patients who underwent robotic Roux-en-Y gastric bypass (RYGB) using the standard technique. Methods A retrospective analysis of a prospectively maintained database was performed including 527 consecutive patients who underwent robotic RYGB between January 1, 2018 and December 31, 2021. Results The mean age of the patients was 41 years, with a male/female sex distribution of 143/384 (27.1%/72.9%). Type 2 diabetes in the pre-operative period was diagnosed in 31% of patients. The median pre-operative body mass index (BMI) was 44.6 kg/m2 (range, 35-64). The mean operation time was 134 min for robotic RYGB, including the docking process. Early (< 30 days) complications included ileus (0.2%), atelectasis (0.2%), thromboembolic (0.2%) events, and surgical-site infection (0.2%). No leakage or bleeding of the gastrojejunal and jejunojejunal anastomoses were recorded. Oral food intake was begun at 1.8 days on average. The average hospital stay was 2 days. Despite a range of BMI values, operation times and gastrojejunal anastomosis times did not show significant differences. There were no significant differences in mean operation time or mean gastrojejunal anastomosis time over the years. Conclusions The robotic approach is effective and safe for patients undergoing RYGB. This technique provides satisfactory results with short-term surgical outcomes. However, the real benefits of robotic RYGB should be further evaluated by well-conducted randomized trials. Even in difficult cases with higher BMI values, optimal operation times and similar operative efficiency can be obtained if a standard operation technique is applied.
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Affiliation(s)
| | - Aydin Yavuz
- Department of General Surgery, Gazi University, Ankara, Turkey
| | - Kursat Dikmen
- Department of General Surgery, Gazi University, Ankara, Turkey
| | | | - Safa Ozaydin
- Department of General Surgery, Gazi University, Ankara, Turkey
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Vilallonga R, García Ruiz de Gordejuela A, Fort JM, Gonzalez O, Rodríguez-Luna MR, Roriz-Silva R, Caubet E, Ciudin A, Pera-Ferreruela M, Petrola C, Armengol M. Laparoscopic Versus Robot-Assisted Roux-en-Y Gastric Bypass: A Center of Excellence for the EAC-BC Experience. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34612707 DOI: 10.1089/lap.2021.0528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: After the first laparoscopic Roux-en-Y gastric bypass (RYGB) in 1994 by Wittgrove, the introduction of robot-assisted procedures was the next step in the surgical race to reduce invasiveness. This breakthrough allowed us to perform bariatric surgery with less surgical trauma in obese patients with metabolic disorders, producing an exponential increase in procedures performed. Methods: This is a retrospective cohort study of a prospective database for patients who underwent RYGB during a 7-year period through two different approaches, laparoscopic and robotic. The robotic cases were performed by two generations of the da Vinci platform (S and Xi), and three groups were identified and compared (L-RYGB, RYGB-S, and RYGB-Xi). Results: A total of 495 patients underwent RYGB, of which 224 by laparoscopy (45.2%) and 271 by robotic approach (54.7%): 134 RYGB-S and 137 RYGB-Xi. The majority of the patients (71.1%) were females, with a mean age of 46.2 years and a mean body mass index of 44 kg/m2. The mean intraoperative time and intraoperative complication rate were higher in the robotic groups, especially in the RYGB-S group. Postoperative complications were higher in the same group, with a rate of 11.9%, where the main leakage occurred on the upper part of the gastric pouch and not in the hand-sewed robotic anastomosis (7.5%). General mortality was 0.6%. We found no significant differences at 1-year percentage of total weight loss (%TWL); at 2 years, the RYGB-Xi group had the lowest %TWL (25.24 ± 14.54, P ≤ .001). Conclusions: The present study reflects our experience during the robotic bariatric introduction and performance since 2011. Features of the da Vinci S platform along our learning curve may explain a higher complication rate. The patients who have been operated by the RYGB-Xi system had lower complications than the laparoscopic group. The robotic approach did not differ with laparoscopy in terms of weight loss and chronic complications after 24 months of follow-up.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
- ELSAN Clinic, Surgery Department, Clinique Saint Michel, Av. D'orient, Toulon, France
| | - Amador García Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Rita Rodríguez-Luna
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Renato Roriz-Silva
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Medicine, Federal University of Rondonia, Rondonia, Brazil
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Ciudin
- Department of Endocrinolgy and Nutrition and Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Meritxell Pera-Ferreruela
- Department of General Surgery, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Petrola
- Department of General Surgery, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Armengol
- Department of General Surgery, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
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Does conversion during minimally invasive rectal surgery for cancer have an impact on short-term and oncologic outcomes? Results of a retrospective cohort study. Surg Endosc 2021; 36:3558-3566. [PMID: 34398282 DOI: 10.1007/s00464-021-08679-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although minimally invasive rectal surgery (MIRS) for cancer provides better recovery for similar oncologic outcomes over open approach, conversion is still required in 10% and its impact on short-term and long-term outcomes remains unclear. The aim of our study was to evaluate the impact of conversion on postoperative and oncologic outcomes in patients undergoing MIRS for cancer. METHODS From June 2011 to March 2020, we reviewed 257 minimally invasive rectal resections for cancer recorded in a prospectively maintained database, with 192 robotic and 65 laparoscopic approaches. Patients who required conversion to open (Conversion group) were compared to those who did not have conversion (No conversion group) in terms of short-term, histologic, and oncologic outcomes. Univariate and multivariate analyses of the risk factors for postoperative morbidity were performed. RESULTS Eighteen patients (7%) required conversion. The conversion rate was significantly higher in the laparoscopic approach than in the robotic approach (16.9% vs 3.6%, p < 0.01). Among the 4 reactive conversions, 3 (75%) were required during robotic resections. Patients in the Conversion group had a higher morbidity rate (83.3% vs 43.1%, p = 0.01) and more severe complications (38.9%, vs 18.8%, p = 0.041). Male sex [HR = 2.46, 95%CI (1.41-4.26)], total mesorectal excision [HR = 2.89, 95%CI (1.57-5.320)], and conversion (HR = 4.87, 95%CI [1.34-17.73]) were independently associated with a higher risk of overall 30-day morbidity. R1 resections were more frequent in the Conversion group (22.2% vs 5.4%, p = 0.023) without differences in the overall (82.7 ± 7.0 months vs 79.4 ± 3.3 months, p = 0.448) and disease-free survivals (49.0 ± 8.6 months vs 70.2 ± 4.1 months, p = 0.362). CONCLUSION Conversion to laparotomy during MIRS for cancer was associated with poorer postoperative results without impairing oncologic outcomes. The high frequency of reactive conversion due to intraoperative complications in robotic resections confirmed that MIRS for cancer is a technically challenging procedure.
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The Impact of Robotics in Learning Roux-en-Y Gastric Bypass: a Retrospective Analysis of 214 Laparoscopic and Robotic Procedures : Robotic Vs. Laparoscopic RYGB. Obes Surg 2021; 30:2403-2410. [PMID: 32124220 PMCID: PMC7475058 DOI: 10.1007/s11695-020-04508-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Proximal Roux-en-Y gastric bypass is commonly used to manage obesity, performed using laparoscopic or robot-assisted minimally invasive surgery. As the prevalence of robotic bariatric surgery increases, further data is required to justify its use. METHODS This was a large, retrospective analysis of prospectively recorded data for Roux-en-Y gastric bypass (RYGB) procedures performed using laparoscopic (LRYGB) or robotic (RRYGB; da Vinci Xi system, Intuitive Surgical Sàrl) surgery between January 2016 and March 2019. The surgical techniques did not differ apart from different trocar placements. Data collected included patient characteristics before and after RYGB, operative outcomes and complications. RESULTS In total, 114 RRYGB and 108 LRYGB primary surgeries were performed. There were no significant differences between the groups, apart from a significantly shorter duration of surgery (116.9 vs. 128.9 min, respectively), lower C-reactive protein values at days 1 (31.1 vs. 44.1 mg/l) and 2 (50.3 vs. 77.8 mg/l) after the intervention, and overall complication rate (4.4 vs. 12.0%, Clavien-Dindo classification II-V) with RRYGB compared with LRYGB. There was a lower hemoglobin value in the postoperative course after RRYGB (12.1 vs. 12.6 g/dl, day 2). CONCLUSIONS In our experience, robotic RYGB has proven to be safe and efficient, with a shorter duration of surgery and lower rate of complications than laparoscopic RYGB. RRYGB is easier to learn and seems safer in less experienced centers. Increasing experience with the robotic system can reduce the duration of surgery over time. Further studies with higher evidence level are necessary to confirm our results.
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The Role of Robotics in Bariatric Surgery. CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00277-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Valverde A, Abdallah S, Danoussou D, Goasguen N, Jouvin I, Oberlin O, Lupinacci RM. Transitioning From Open to Robotic Liver Resection. Results of 46 Consecutive Procedures Including a Majority of Major Hepatectomies. Surg Innov 2020; 28:309-315. [PMID: 32857664 DOI: 10.1177/1553350620954580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aims. Minimally invasive liver resection is a complex and challenging operation. Although authors have reported robotic liver resection shows improved safety and efficacy compared with open liver resection, robotic major liver resections for malignant liver lesions treatment remain inadequately evaluated. The aims of the present study were to evaluate the feasibility and safety of transitioning from open to robotic liver resection in a nonuniversity hospital. Patients and Methods. From December 2015 to March 2020, 46 patients underwent totally robotic-assisted liver resections out of 446 robotic procedures. Also, we retrospectively reviewed the last 27 open right hepatectomies (ORHs) and compared then with the first 25 anatomic robotic-assisted right hepatectomies (RRHs). Results. Mean operative time, mean blood lost, rate of complications, and mean hospital stay were associated with the complexity of the procedure. The comparison between ORH and RRH showed that intraoperative complications were less frequently observed during ORH whereas RRH showed a trend in favor of less blood loss. ORH had a trend toward smaller surgical margins and higher rate of R1 resections. Recurrence occurred in 31 (59%) patients and was more frequently observed after ORH. However, the mean follow-up was significantly shorter after RRH. Conclusion. Our study demonstrated the technical feasibility and safety of transitioning from open to robotic liver resection (including major hepatectomies) in a nonuniversity setting. Higher costs remain an important drawback for robotic surgery.
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Affiliation(s)
- Alain Valverde
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Solafah Abdallah
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Divya Danoussou
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Nicolas Goasguen
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Ingrid Jouvin
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Olivier Oberlin
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France
| | - Renato M Lupinacci
- Service de Chirurgie Digestive, 158498GH Diaconesses Croix Saint Simon, Paris, France.,Service de Chirurgie Digestive, Oncologique et Métabolique, Hôpital Ambroise Paré - APHP, Boulogne-Billancourt, France.,UFR des Sciences de la Santé Simone Veil, Université de Versailles-Saint-Quentin-en-Yvelines et Université Paris-Saclay, France
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Beckmann JH, Mehdorn AS, Kersebaum JN, von Schönfels W, Taivankhuu T, Laudes M, Egberts JH, Becker T. Pros and Cons of Robotic Revisional Bariatric Surgery. Visc Med 2020; 36:238-245. [PMID: 32775356 DOI: 10.1159/000507742] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/03/2020] [Indexed: 01/06/2023] Open
Abstract
Introduction Revisional procedures in bariatric surgery are regarded as technically more demanding and riskier than primary interventions. While the use of the surgical robot has not yet proven to be advantageous in primary bariatric interventions, the question remains whether its use is justified for more complex revisional procedures. Objective To show that revisional bariatric surgery can be performed safely using the da Vinci® Xi surgical system. Methods We performed a retrospective analysis of prospectively recorded data for revisional bariatric procedures between January 2016 and November 2019. Results Of 78 revision operations, four (5.1%) were performed by open surgery, 30 (38.5%) by laparoscopic surgery, and 44 (56.4%) by robotic surgery. A comparative analysis of robotic (n = 41) versus laparoscopic (n = 18) revisional Roux-en-Y gastric bypasses (rRYGB) revealed significant differences favoring the robotic approach for operative time (130.7 vs. 167.6 min), C-reactive protein values at days 1 (27.9 vs. 49.1 mg/L) and 2 (48.2 vs. 83.6 mg/L) after surgery, and length of stay (4.9 vs. 6.2 days). Lower complication rates (Clavien-Dindo II-V) were found after rRRYGB (7.3 vs. 22.2%, not significant). Conclusions Revisional bariatric surgery using a robotic system is safe. The operative time performing rRRYGB is significantly shorter than rLRYGB in our experience. Otherwise, results were largely comparable. Due to different indications, different index operations and a wide range of revisional procedures, further studies are necessary to confirm these results.
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Affiliation(s)
- Jan Henrik Beckmann
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Anne-Sophie Mehdorn
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan-Niclas Kersebaum
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Witigo von Schönfels
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Terbish Taivankhuu
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Matthias Laudes
- I. Department of Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan-Hendrik Egberts
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thomas Becker
- Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt-Semm Center for Laparoscopic and Robotic Assisted Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Wu CZ, Klebanoff JS, Tyan P, Moawad GN. Review of strategies and factors to maximize cost-effectiveness of robotic hysterectomies and myomectomies in benign gynecological disease. J Robot Surg 2019; 13:635-642. [PMID: 30919259 DOI: 10.1007/s11701-019-00948-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/19/2019] [Indexed: 12/15/2022]
Abstract
Common benign gynecologic procedures include hysterectomies and myomectomies, with hysterectomy being the most common gynecologic procedure in the United States [1]. While historically performed via laparotomy, the field of gynecologic surgery was revolutionized with the advent of laparoscopic techniques, with the most recent advancement being the introduction of robotic-assisted surgery in 2005. Robotic surgery has all the benefits of laparoscopic surgery such as decreased blood loss, quicker return to activities, and shorter length of hospital stay. Additional robotic-specific advantages include but are not limited to improved ergonomics, 3D visualization, and intuitive surgical movements. Despite these advantages, one of the most commonly cited drawbacks of robotic surgery is the associated cost. While the initial cost to purchase the robotic console and its associated maintenance costs are relatively high, robotic surgery can be cost-effective when utilized correctly.This article reviews application strategies and factors that can offset traditional costs and maximize the benefits of robotic surgery.
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Affiliation(s)
- Catherine Z Wu
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA
| | - Jordan S Klebanoff
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA
| | - Paul Tyan
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The University of North Carolina, Chapel Hill, NC, USA
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA.
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