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Edwards MA, Falstin M, Alomari M, Spaulding A, Brennan ER. Robotic Versus Laparoscopic Sleeve Gastrectomy Outcome Trends Over Time: Are We Improving? Obes Surg 2024; 34:2596-2606. [PMID: 38844716 DOI: 10.1007/s11695-024-07334-x] [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: 02/11/2024] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is an effective treatment option for patients with obesity. Robotic sleeve gastrectomy (RSG) is reported to have worse short-term patient outcomes compared to laparoscopic SG (LSG), but prior studies may not have accounted for evolving technology, including stapler utilization. OBJECTIVE This study compared RSG and LSG outcomes over different time periods. SETTING Academic Hospital. MATERIAL AND METHODS The 2015 to 2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) databases were used. Matched cohort analyses compared adverse outcomes within 30 days for the 2015-2018 and 2019-2021 cohorts. Bivariate and regression models compared cohorts using Stata/MP 17.0. RESULTS Seven hundred sixty-eight thousand and sixty-nine SG were analyzed. Over the 7-year study period, all patient outcomes, operation length (OL), and length of stay (LOS) trended downward for RSG, except surgical site infection (SSI). In the 2015-2018 cohort, leak was significantly higher with RSG (OR 1.53), and OL and LOS longer (p < 0.001). In the 2019-2021 cohort which corelated with a significant increase in robotic cases, leak (OR 1.36), SSI (OR 1.46), and morbidity (OR 1.11) were higher with RSG. While the mean difference in OL and LOS decreased between the two time periods, they remain longer for RSG (p < 0.001). CONCLUSION While RSG and LSG are safe with similar mortality, RSG continues to be associated with higher rates of morbidity, leak, and SSI, as well as longer OL, hospital LOS, and higher cost. The study is limited by the ability to account for the impact of surgeon experience and stapler utilization on outcomes.
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Affiliation(s)
- Michael A Edwards
- Department of Surgery, Division of Advanced GI and Bariatric Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
| | - Mark Falstin
- Department of Surgery, Division of Advanced GI and Bariatric Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Mohammad Alomari
- Department of Surgery, Division of Advanced GI and Bariatric Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Aaron Spaulding
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Emily R Brennan
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center, Mayo Clinic, Jacksonville, FL, 32224, USA
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Samreen S, Lee SH, Liu Y, Zheng F, Edwards M. Thirty day outcomes for laparoscopic versus robotic sleeve gastrectomy: Does the stapler matter? Am J Surg 2024:115801. [PMID: 38944623 DOI: 10.1016/j.amjsurg.2024.115801] [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: 12/19/2023] [Revised: 03/25/2024] [Accepted: 06/12/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Sleeve gastrectomy (SG) remains a safe and effective treatment for severe obesity. The number of robotic SG (RSG) has steadily increased from 2015 to 2021. Prior studies have shown higher rates of some adverse outcomes with RSG but have not accounted for staplers used. OBJECTIVE The aim of this study is to compare outcomes for RSG compared to laparoscopic sleeve gastrectomy (LSG), accounting for stapler type used. SETTING National hospital derived administrative data. METHODS The PINC AI Healthcare Database was used for the current study. Analyzed cohort included elective LSG or RSG performed between January 1, 2019, and December 31, 2021. Patient, hospital, billing, provider, insurance, and operative data were captured. Bleeding, leak, and other outcomes were identified by ICD-10-CM diagnosis codes. Propensity score matching (PSM) compared outcomes between RSG with SureForm stapler vs. LSG with powered stapler. RESULTS 56,013 LSG and 13,832 RSG were analyzed. RSG increased from 15 % in 2019 to 25 % in 2021 with an absolute 27 % increase in robotic stapler utilization for RSG. PSM analysis compared, 5434 RSG with SureForm Stapler vs. 5434 LSG with powered staplers showed equivalent complication rates, shorter LOS, but longer operative time with RSG. CONCLUSIONS When stapler type used is accounted for, patient outcomes following RSG and LSG are equivalent.
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Affiliation(s)
- Sarah Samreen
- Department of Surgery, University of Texas Medical Branch Galveston, TX, USA
| | - Shih-Hao Lee
- Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale CA, USA
| | - Yuki Liu
- Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale CA, USA
| | - Feibi Zheng
- Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale CA, USA; DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Kang DW, Zhou S, Niranjan S, Rogers A, Shen C. Predicting operative time for metabolic and bariatric surgery using machine learning models: a retrospective observational study. Int J Surg 2024; 110:1968-1974. [PMID: 38270635 PMCID: PMC11019972 DOI: 10.1097/js9.0000000000001107] [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: 09/11/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Predicting operative time is essential for scheduling surgery and managing the operating room. This study aimed to develop machine learning (ML) models to predict the operative time for metabolic and bariatric surgery (MBS) and to compare each model. METHODS The authors used the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database between 2016 and 2020 to develop ML models, including linear regression, random forest, support vector machine, gradient-boosted tree, and XGBoost model. Patient characteristics and surgical features were included as variables in the model. The authors used the mean absolute error, root mean square error, and R 2 score to evaluate model performance. The authors identified the 10 most important variables in the best-performing model using the Shapley Additive exPlanations algorithm. RESULTS In total, 668 723 patients were included in the study. The XGBoost model outperformed the other ML models, with the lowest root mean square error and highest R 2 score. Random forest performed better than linear regression. The relative performance of the ML algorithms remained consistent across the models, regardless of the surgery type. The surgery type and surgical approach were the most important features to predict the operative time; specifically, sleeve gastrectomy (vs. Roux-en-Y gastric bypass) and the laparoscopic approach (vs. robotic-assisted approach) were associated with a shorter operative time. CONCLUSIONS The XGBoost model best predicted the operative time for MBS among the ML models examined. Our findings can be useful in managing the operating room scheduling and in developing software tools to predict the operative times of MBS in clinical settings.
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Affiliation(s)
- Dong-Won Kang
- Department of Surgery, Penn State College of Medicine
| | - Shouhao Zhou
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Suman Niranjan
- Department of Logistics and Operations Management, G. Brint Ryan College of Business, University of North Texas, Denton, Texas, USA
| | - Ann Rogers
- Department of Surgery, Penn State College of Medicine
| | - Chan Shen
- Department of Surgery, Penn State College of Medicine
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Pavone G, Pacilli M, Gerundo A, Quazzico A, Ambrosi A, Tartaglia N. Can robotic gastric bypass be considered a valid alternative to laparoscopy? Our early experience and literature review. Front Surg 2024; 11:1303351. [PMID: 38375411 PMCID: PMC10875057 DOI: 10.3389/fsurg.2024.1303351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
Background Robotic bariatric surgery serves as an alternative to laparoscopy. The technology provides the surgeon with an accurate three-dimensional view, allowing complex maneuvers while maintaining full control of the operating room. Hypothesis We report our experience with this innovative surgery compared with laparoscopy during Roux-en-Y gastric bypass to demonstrate its safety and feasibility. The aim of this study is to evaluate potential differences between the robotic and laparoscopic techniques. Materials and methods Our study retrospectively identified 153 consecutive obese patients who underwent either laparoscopic or robotic gastric bypass (RGB) procedures over a 2-year period at the Department of Medical and Surgical Sciences, University of Foggia. Data on demographics, operative time, conversion rate, length of hospital stay, and mortality were collected and compared between two groups of patients: 82 patients who underwent laparoscopic procedures and 71 who underwent robotic procedures. Results We analyzed 153 patients who underwent gastric bypass with a mean age of 42.58 years, of whom 74 were female; 71 were treated with a robotic approach and 82 with a laparoscopic approach. The mean operative time was 224.75 ± 10.4 min for RGB (including docking time) and 101.22 min for laparoscopic gastric bypass (LGB) (p < 0.05), which is statistically significant. The median length of stay was 4.1 days for the RGB group and 3.9 days for the LGB group (p = 0.89). There is only one conversion to laparoscopy in the RGB group. We observed only one case of postoperative complications, specifically one episode of endoluminal bleeding in the laparoscopic group, which was successfully managed with medical treatment. No mortality was observed in either group. Conclusion The statistical analysis shows to support the robotic approach that had a lower incidence of complications but a longer operative duration. Based on our experience, the laparoscopic approach remains a technique with more haptic feedback than the robotic approach, making surgeons feel more confident.This study has been registered on ClinicalTrial.gov Protocol Registration and Results System with this ID: NCT05746936 for the Organization UFoggia (https://clinicaltrials.gov/ct2/show/NCT05746936).
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Affiliation(s)
- Giovanna Pavone
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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El Chaar M, Petrick A, Clapp B, Stoltzfus J, Alvarado LA. Outcomes of Robotic-Assisted Bariatric Surgery Compared to Standard Laparoscopic Approach Using a Standardized Definition: First Look at the 2020 Metabolic and Bariatric Surgery Accreditation Quality Improvement Project (MBSAQIP) Data. Obes Surg 2023; 33:2025-2039. [PMID: 37184827 DOI: 10.1007/s11695-023-06585-4] [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: 01/24/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE The primary objective of this study is to evaluate the outcomes of robotic-assisted (RA-) approach compared to the standard laparoscopic (L-) approach using the 2020 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry Public Use File (PUF). Our secondary objective is to establish standards for the reporting of outcomes using PUF. MATERIALS AND METHODS Using the PUF database (n = 168,568), patients were divided into sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), revisions, and conversions and then analyzed separately. We created balanced covariate through propensity score matching and inverse probability treatment weighting (IPTW). We also conducted multivariable relative risk regression to confirm our results. RESULTS For RYGB, the incidence of "transfusion" was significantly lower in the RA-RYGB compared to the L-RYGB. There was no significant difference in the rate of Serious Event Occurrences (SEOs) or rate of intervention at 30 days. For SG, there was a higher rate of "transfusion" in the RA group. Incidence of SEOs was also significantly higher in the RA-group. There was no significant difference in SEOs for conversions; however, revisions had a trend toward a lower rate of SEOs favoring the robotic approach. Operative times were significantly higher for all RA-groups. CONCLUSION RA- approach in metabolic and bariatric surgery (MBS) remains controversial because of differences in outcomes. The use of SEOs as reported by MBSAQIP in its semi-annual report can be used as a composite score to assess outcomes while using PUF. Further studies are needed to compare RA- to L- MBS.
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Affiliation(s)
- Maher El Chaar
- Department of Surgery, St Luke's University Hospital and Health Network, 1736 Hamilton Street, Allentown, PA, 18104, USA.
| | - Anthony Petrick
- Geisinger Clinic, 100 N Academy Ave, Danville, PA, 17821, USA
| | - Benjamin Clapp
- Texas Tech Health Sciences Cente School of Medicine, 4801 Alberta Ave, El Paso, TX, 79905, USA
| | - Jill Stoltzfus
- St Luke's University Hospital and Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Luis A Alvarado
- Texas Tech University Health Sciences Center, 4801 Alberta Ave, El Paso, TX, 79905, USA
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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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Dudash M, Saeed K, Wang S, Johns A, Colonie R, Falvo A, Horsley R, Gabrielsen J, Petrick AT, Parker DM. A comparative evaluation of robotic and laparoscopic Roux-en-Y gastric bypass: a critical evaluation on the impact of postoperative pain and opioid requirements. Surg Endosc 2022; 36:7700-7708. [PMID: 35199202 DOI: 10.1007/s00464-022-09124-x] [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: 09/14/2021] [Accepted: 02/07/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The benefits of minimally invasive surgery using laparoscopy on postoperative pain and opioid use are well established. Our goal was to determine whether patients who underwent Roux-en-Y gastric bypass using a robotic approach (RA-RYGB) had lower postoperative pain and required less opioids than those undergoing laparoscopic Roux-en-Y gastric bypass (L-RYGB). Secondary outcomes evaluated included length of stay, operative time, and readmissions. METHODS AND PROCEDURES This was a retrospective cohort study from a tertiary academic medical center. Patients who underwent L-RYGB or RA-RYGB between 5/1/2018 and 10/31/2019 were included. Cases with concomitant hernia repair, chronic opioid use, and those who did not receive a TAP block or multimodal pain control were excluded. Baseline demographics were compared. Inpatient and outpatient opioid use in Morphine Milligram Equivalents (MME) and pain scores (10-point Likert scale) were compared. RESULTS There were 573 RY patients included (462 L-RYGB; 111 RA-RYGB). Median and maximum inpatient pain scores were similar for L-RYGB and RA-RYGB (3.0 vs 3.1, p = 0.878; 7.0 vs 7.0, p = 0.688). Median inpatient opioid use and maximum single day use were similar for L-RYGB and RA-RYGB (40.0 MME vs. 42.0 MME, p = 0.671; 30.0 MME vs 30.0 MME, p = 0.648). Both the outpatient prescribing of opioids (50.2% vs. 42.3%, p = 0.136) and outpatient opioid MME at 2 weeks (L-RYGB 30.0 MME vs. 33.8 MME, p = 0.854) were comparable between cohorts. Patient reported pain at 2-week follow-up was significantly higher for RA-RYGB (68.1%) than L-RYGB (55.6%) (p = 0.030). RA-RYGB had a higher rate of 30-day readmission and longer operative times compared to the L-RYGB (6.3% vs 13.5%, p = 0.010; 144.5 vs 200.0 min, p < 0.001). CONCLUSION This study identified no benefit for postoperative pain or opioid requirements in patients undergoing RA-RYGB compared to L-RYGB. The RA-RYGB group was significantly more likely to report pain at the two-week follow-up.
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Affiliation(s)
- Mark Dudash
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Kashif Saeed
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Shengxuan Wang
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Alicia Johns
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Ryan Colonie
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Alexandra Falvo
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Ryan Horsley
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Jon Gabrielsen
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Anthony T Petrick
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - David M Parker
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA.
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Dimou FM, Ackermann N, Chang SH, Freeman D, Eagon JC, Eckhouse SR. Understanding the Current Role of Robotic-Assisted Bariatric Surgery. Obes Surg 2021; 31:3130-3137. [PMID: 33783678 DOI: 10.1007/s11695-021-05375-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/13/2021] [Accepted: 03/22/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The role of robotic surgery in bariatrics remains controversial. Patient selection for robotic surgery is not well-studied. The objective of this study was to identify factors associated with robotic surgery and its temporal trends. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database from 2015 to 2018 was used. Adult patients undergoing primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) using the laparoscopic or robotic approach were identified. Revisional, hybrid, or those with concomitant procedures were excluded. Logistic regression was conducted to identify factors associated with undergoing robotic-assisted surgery. RESULTS Among 211,568 patients who underwent SG, 9.1% underwent a robotic SG; among 76,805 patients who underwent RYGB, 7.9% of patients underwent a robotic RYGB. During 2015-2018, robotics increased from 7.1 to 11.3% for SG and 7.4 to 8.6% for RYGB. After controlling for patient characteristics, there was still an increasing trend in the use of robotic surgery: SG (multivariable-adjusted odds ratio, aOR, 1.18; 95% confidence interval, CI, 1.17-1.20) and RYGB (aOR, 1.05; 95% CI, 1.03-1.08). For both robotic SG and RYGB, functional status and African American race were associated with undergoing robotic surgery, while races other than White or African American and Hispanic ethnicity were not. Pre-operative IVC filter was associated with robotic SG, while the presence of GERD, diabetes, and COPD were associated with robotic RYGB. CONCLUSIONS Robotic bariatric surgery has increased over time. Our findings identified factors associated with the receipt of robotic surgery. Reasons for these factors require further investigation to better delineate indications for this technology.
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Affiliation(s)
- Francesca M Dimou
- Department of Surgery, Washington University in Saint Louis School of Medicine, 660 South Euclid Ave Campus Box 6109, Saint Louis, MO, 63110, USA.
| | - Nicole Ackermann
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Dawn Freeman
- Department of Surgery, Washington University in Saint Louis School of Medicine, 660 South Euclid Ave Campus Box 6109, Saint Louis, MO, 63110, USA
| | - J Christopher Eagon
- Department of Surgery, Washington University in Saint Louis School of Medicine, 660 South Euclid Ave Campus Box 6109, Saint Louis, MO, 63110, USA
| | - Shaina R Eckhouse
- Department of Surgery, Washington University in Saint Louis School of Medicine, 660 South Euclid Ave Campus Box 6109, Saint Louis, MO, 63110, USA
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The Longitudinal Efficiency of Robotic Surgery: an MBSAQIP Propensity Matched 4-Year Comparison of Robotic and Laparoscopic Bariatric Surgery. Obes Surg 2021; 30:3706-3713. [PMID: 32495073 DOI: 10.1007/s11695-020-04712-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The objective of this study was to examine the MBSAQIP database to assess efficiency trends and perioperative outcomes in robotic bariatric surgery. METHODS Robotic (RA) and laparoscopic (L) sleeve gastrectomy (SG) and gastric bypass (RYGB) were compared using the 2015-2018 MBSAQIP Participant Use Data Files. Patients were propensity matched 1:1 based on sex, body mass index, assistant, and previous obesity or foregut surgery. A total of 93,802 patients were included. RESULTS Median operative times were significantly longer for both RA-SG (89 vs. 62 min; p < 0.0001) and RA-RYGB (141 vs. 105 min; p < 0.0001) compared with laparoscopic. Over the 4-year period, the difference in operative times (OR delta) between RA-SG and L-SG was unchanged while the difference in operative times between RA-RYGB and L-RYGB increased. Both robotic groups were significantly more likely to be readmitted (RA-SG p = 0.001, RA-RYGB p = 0.006). Robotic SG was more likely to have a reintervention (p = 0.018) and extended length of stay (LOS) (> 4 days) compared with laparoscopic (p = < 0.0002). No significant differences were noted in morbidity and mortality by approach. CONCLUSIONS Operative times were 30% longer for RA-SG and 25% longer for RA-RYGB when compared with laparoscopic. There was no significant improvement in OR delta for either RA-SG or RA-RYGB over the four years. Readmission rates were higher for both RA-SG and RA-RYGB. Robotic SG had a greater percentage of patients with extended LOS compared with laparoscopic. No evidence of improved efficiency for robotic bariatric surgery as defined by operative time or clinical outcomes was identified.
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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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Kersebaum JN, Möller T, von Schönfels W, Taivankhuu T, Becker T, Egberts JH, Beckmann JH. Robotic Roux-en-Y Gastric Bypass Procedure Guide. JSLS 2021; 24:JSLS.2020.00062. [PMID: 33293782 PMCID: PMC7678257 DOI: 10.4293/jsls.2020.00062] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose This is a step-by-step procedural guide to help new and unexperienced surgeons with the implementation of a robotic program for the surgical treatment of morbid obesity. Methods Based on our vast robotic experience, we present our standardized technique and also, with a PubMed research, discuss the different surgical aspects. Results We present our trainings pathway towards the first robotic Roux-en-Y gastric bypass, a step-by-step procedural guide with helpful hints when it comes to troubleshooting and also discuss some surgical aspects. Conclusion The robotic Roux-en-Y gastric bypass is safe and feasible, and might offer some advantages in comparison to the laparoscopic approach.
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Affiliation(s)
- Jan-Niclas Kersebaum
- University Medical Center Schleswig-Holstein, Campus Kiel, Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Thorben Möller
- University Medical Center Schleswig-Holstein, Campus Kiel, Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Witigo von Schönfels
- University Medical Center Schleswig-Holstein, Campus Kiel, Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Terbish Taivankhuu
- University Medical Center Schleswig-Holstein, Campus Kiel, Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Thomas Becker
- University Medical Center Schleswig-Holstein, Campus Kiel, Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Jan-Hendrik Egberts
- University Medical Center Schleswig-Holstein, Campus Kiel, Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Jan Henrik Beckmann
- University Medical Center Schleswig-Holstein, Campus Kiel, Department of General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Arnold-Heller-Str. 3, 24105 Kiel, Germany
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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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Falvo AM, Vacharathit V, Dove J, Fluck M, Daouadi M, Gabrielsen J, Horsley R, Petrick A, Parker DM. A 3-Year MBSAQIP propensity-matched analysis of Roux-en-Y gastric bypass with concomitant cholecystectomy: Is the robotic or laparoscopic approach preferred? Surg Endosc 2020; 35:4712-4718. [PMID: 32959181 DOI: 10.1007/s00464-020-07939-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The primary objective of this study was to compare outcomes of patients undergoing minimally invasive RYGB (MIS/RYGB) versus MIS/RYGB with concomitant Cholecystectomy (CCY). A secondary objective was to compare the outcomes for laparoscopic RYGB (LRYGB) and robotic RYGB (RRYGB) with concomitant CCY. METHODS Outcomes of 117,939 MIS/RYGB with and without CCY were propensity-matched (Age, Gender, BMI, Comorbidities), 10:1, using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from 2015-2017. The MIS/RYGB with CCY were then separated into LRYGB and RRYGB cases for comparison. Exclusion criteria included emergency cases, conversions to open, and age less than 18. RESULTS The operative time and length of stay (LOS) was significantly increased with addition of concomitant CCY. There was no significant difference in readmission, reoperation, intervention, morbidity, or mortality. The RRYGB with CCY approach was associated with a significantly longer operative times compared to the LRYGB with CCY (177 vs. 135 min, p < 0.0001). The laparoscopic and robotic groups demonstrated no significant difference LOS, readmission, reoperation, intervention, morbidity, or mortality rates. CONCLUSIONS Our study demonstrates that concomitant cholecystectomy increased the operative time and length of stay. However, concomitant CCY was not associated with any increased morbidity. The study demonstrated no significant difference in morbidity between robotic and laparoscopic approach. The robotic approach, however, was associated with a significantly longer operative time compared to the laparoscopic approach. While the indications for CCY remain controversial, concomitant CCY does not convey additional risk regardless of operative approach.
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Affiliation(s)
- Alexandra M Falvo
- Geisinger Medical Center, 100 N Academy Drive, Danville, PA, 17822, USA
| | | | - James Dove
- Geisinger Medical Center, 100 N Academy Drive, Danville, PA, 17822, USA
| | - Marcus Fluck
- Geisinger Medical Center, 100 N Academy Drive, Danville, PA, 17822, USA
| | - Mustapha Daouadi
- Geisinger Medical Center, 100 N Academy Drive, Danville, PA, 17822, USA
| | - Jon Gabrielsen
- Geisinger Medical Center, 100 N Academy Drive, Danville, PA, 17822, USA
| | - Ryan Horsley
- Geisinger Commonwealth Medical Center, Scranton, USA
| | - Anthony Petrick
- Geisinger Medical Center, 100 N Academy Drive, Danville, PA, 17822, USA
| | - David M Parker
- Geisinger Medical Center, 100 N Academy Drive, Danville, PA, 17822, USA.
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Janik M, Ibikunle C, Khan A, Aryaie AH. Safety of Single Stage Revision Laparoscopic Sleeve Gastrectomy Compared to Laparoscopic Roux-Y Gastric Bypass after Failed Gastric Banding. Obes Surg 2020; 31:588-596. [PMID: 32946032 PMCID: PMC7847865 DOI: 10.1007/s11695-020-04975-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/19/2022]
Abstract
Background Reoperation, after failed gastric banding, is a controversial topic. A common approach is band removal with conversion to laparoscopic Roux-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) in a single-step procedure. Objective This study aimed to assess the safety of revisional surgery to LSG compared to LRYGB after failed laparoscopic adjustable gastric banding (LAGB) based on MBSAQIP Participant User File from 2015 to 2018. Methods Patients who underwent a one-stage conversion of LAGB to LSG (Conv-LSG) or LRYGB (Conv-LRYGB) were identified in the MBSAQIP PUF from 2015 to 2017. Conv-LRYGB cases were matched (1:1) with Conv-LSG patients using propensity scoring to control for potential confounding. The primary outcome was all-cause mortality. Results A total of 9974 patients (4987 matched pairs) were included in the study. Conv-LRYGB, as compared with conv-SG, was associated with a similar risk of mortality (0.02% vs. 0.06%; relative risk [RR], 0.33; 95% confidence interval [CI], 0.03 to 3.20, p = 0.32). Conversion to LRYGB increased the risk for readmission (6.16% vs. 3.77%; RR, 1.63; 95%CI, 1.37 to 1.94, p < 0.01); reoperation (2.15% vs. 1.36%; RR, 1.57; 95%CI, 1.17 to 2.12, p = <0.01); leak (1.76% vs. 1.02%; RR, 1.57; 95%CI, 1.72 to 2.42, p < 0.01); and bleeding (1.66% vs. 1.00%; RR, 1.66; 95%CI, 1.7 to 2.34, p < 0.01). Conclusions The study shows that single-stage LRYGB and LSG as revisional surgery after gastric banding, are safe in the 30-day observation with an acceptable complication rate and low mortality. However, conversion to LRYGB increased the risk of perioperative complications.
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Affiliation(s)
- Michał Janik
- Bariatric Center of Excellence, Department of surgery, Texas Tech University Health Science Center, Lubbock, TX, USA. .,Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warszawa, Poland.
| | - Christopher Ibikunle
- Medical College of Georgia, Augusta, GA, USA.,Bariatric and Reflux Center, Georgia SurgiCare, Atlanta, GA, USA
| | - Ahad Khan
- Bariatric and Reflux Center, Georgia SurgiCare, Atlanta, GA, USA
| | - Amir H Aryaie
- Bariatric Center of Excellence, Department of surgery, Texas Tech University Health Science Center, Lubbock, TX, USA.,Bariatric and Reflux Center, Georgia SurgiCare, Atlanta, GA, USA
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Tatarian T, Yang J, Wang J, Docimo S, Talamini M, Pryor AD, Spaniolas K. Trends in the utilization and perioperative outcomes of primary robotic bariatric surgery from 2015 to 2018: a study of 46,764 patients from the MBSAQIP data registry. Surg Endosc 2020; 35:3915-3922. [PMID: 32737605 DOI: 10.1007/s00464-020-07839-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Utilization of robotic surgery has increased over time. Outcomes in bariatric surgery have been variable. This study used the Metabolic and Bariatric Surgery Accreditation Quality and Improvement Program (MBSAQIP) dataset to compare nationwide trends in utilization and outcomes improvement for robotic and laparoscopic bariatric surgery over a four-year period. METHODS We identified all adult patients who underwent robotic or laparoscopic primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from 2015 to 2018. Those with previous bariatric/foregut surgery or open conversion were excluded. Trends in clinical outcomes of different surgery types over years were compared through multivariable regression models. Subgroup analysis was performed for patients in 2018, comparing outcomes among different surgery types. RESULTS A total of 571,417 patients underwent bariatric surgery, of which 46,764 (8.2%) were performed robotically. Utilization of the robotic platform increased annually, from 6.7% in 2015 to 10.3% in 2018 (p < 0.0001). The majority of patients underwent SG (n = 33,891, 72.5%). Perioperative outcomes improved over time for both robotic and laparoscopic procedures. Improvement was more pronounced in the robotic cohort for extended length of stay (OR 0.76 vs 0.8, p < 0.0001) and operative time (OR 0.98 vs 0.99, p < 0.0001). In the 2018 subgroup, multivariable analysis found laparoscopic RYGB was associated with increased bleeding (OR 2.220, p = 0.0004), overall complications (OR 1.356, p = 0.0013), and extended LOS (OR 1.178, p < 0.0001) compared to robotic surgery. Laparoscopic SG was associated with decreased anastomotic/staple line leak (OR 0.718, p = 0.0321), 30-d readmission (OR 0.826, p = 0.0005), 30-d reintervention (OR 0.723, p = 0.0014), overall event (OR 0.862, p = 0.0009), and extended LOS (OR 0.950, p = 0.0113). Across the board, laparoscopic surgery was associated with decreased operative time (Adjusted Ratio = 0.704, p < 0.0001). CONCLUSION Robotic utilization for bariatric surgery is increasing and outcomes continue to improve with time. There is a differential impact of the robotic approach on SG and RYGB, which requires further assessment.
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Affiliation(s)
- Talar Tatarian
- Division of Bariatric Surgery, Department of Surgery, Thomas Jefferson University, 211 S 9th Street, Suite 402, Philadelphia, PA, 19107, USA.
| | - Jie Yang
- Division of Epidemiology and Biostatistics, Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Junying Wang
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Salvatore Docimo
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Mark Talamini
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Aurora D Pryor
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Konstantinos Spaniolas
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University, Stony Brook, NY, USA
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Kurien R, Menon S. Balloon dilation in sleeve gastrectomy stenosis: a simple solution to an occasionally tricky problem. Gastrointest Endosc 2020; 91:1003-1004. [PMID: 32327116 DOI: 10.1016/j.gie.2019.12.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 12/27/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Reuben Kurien
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Shyam Menon
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Clapp B, Klingsporn W, Lee I, Liggett E, Barrientes A, Harper B, Tyroch A. Trends in bariatric surgery in Texas: an analysis of a statewide administrative database 2013–2017. Surg Endosc 2020; 35:1566-1571. [DOI: 10.1007/s00464-020-07533-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/31/2020] [Indexed: 01/12/2023]
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Iranmanesh P, Bajwa KS, Felinski MM, Shah SK, Wilson EB. Robotic Primary and Revisional Bariatric Surgery. Surg Clin North Am 2020; 100:417-430. [DOI: 10.1016/j.suc.2019.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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