Conversion of laparoscopic adjustable gastric band to robot-assisted laparoscopic biliopancreatic diversion with duodenal switch

Robotic Duodenal Switch Is Associated with Outcomes Comparable to those of Laparoscopic Approach

Introduction/Purpose

This study evaluates the outcomes of robotic duodenal switch (RDS) when compared to conventional laparoscopy (LDS).

Materials and Methods

Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), patients who underwent RDS were compared to those of LDS (2015–2018) for perioperative characteristics and thirty-day postoperative outcomes. Operative complexity, complications, and resource utilization trends were plotted over the included years for the two approaches. Multivariable analysis was conducted to characterize the impact of each approach on these outcomes.

Results

Of 7235 minimally invasive operations, 5720 (79.1%) were LDS while 1515 (20.9%) were RDS. Intraoperative endoscopy, anastomosis testing, and shorter operative duration were associated with LDS. RDS group had more concomitant procedures with less attending assistance. The odds ratios of organ space infection and sepsis were equivalent. RDS increased the odds ratios for venous thromboembolism [VTE] (odds ratio [OR] = 2.3, 95% confidence interval [CI] = 1.1–4.8, p = 0.02) and early discharge (OR = 7.3, CI = 4.9–10.9, p < 0.01). The difference in wound infection between LDS and RDS has been decreasing (1.5% and 1.5% in 2018 from 2.3% and 4.1% in 2015, respectively) over the years. Similarly, the decreasing trends were noted for systemic infections.

Conclusion

While the development of VTE after RDS was higher, most of the other complications were comparable between LDS and RDS in this study. RDS may reduce the need for advanced intraoperative assistance and minimize hospital stay in select cases, without increasing morbidity. The recent trends suggest a gradual decrease in the variations between LDS and RDS outcomes over time.

The evolution of robotic bariatric surgery

INTRODUCTION

The growth of bariatric surgery has resulted in varying types of procedures with increasing complexity. Robotic digital platforms are employed in bariatric surgery to address this increasing complexity in the high-risk obese patient population with difficult anatomy.

MATERIALS AND METHODS

This review explores the literature and examines the reported outcomes and complications in using robotics for bariatric surgery. Robotic approaches to adjustable gastric banding, sleeve gastrectomy, gastric bypass, and biliopancreatic diversion with duodenal switch are examined. Revisional cases, learning curves, and cost effectiveness are reviewed, with an eye toward the future of bariatric surgery as the use of robotics is adopted.

CONCLUSION

Digital platforms are showing great promise as enabling technology which advance bariatric outcomes. With increasingly complex bariatric cases being performed and revised, the insertion of digital information between the surgeon and the patient leads to better operations for the patient and the surgeon.