Background

Recent meta-analyses and registry reports find that primary metabolic bariatric surgeries (MBS) performed robotic have similar outcomes to conventional laparoscopy but with longer operative times and higher costs. Most of the robotic surgeries in these reports, however, were robot-assisted rather than totally (fully) robotic. In this study, we examine the surgical outcomes of primary MBS (RYGB, SG, DS) performed totally robotic (TR) vs. laparoscopic (LAP).

Methods

The study is a retrospective analysis of 809 (498 TR, 311 LAP) primary MBS, i.e. RYGB n=351, SG n=393, DS n=65, performed by a single surgeon between 1/20-11/23. Outcomes included patient characteristics (age, weight, BMI, gender, preoperative health status), operative time, length of stay (LOS), complications.

Results

Characteristics of the TR and LAP patients were nearly identical. For the RYGB, operative times were significantly lower with the TR vs. LAP approach (97.6 vs. 115.4 min, respectively, p<0.0001); LOS was shorter (1.19 TR vs. 1.39 d LAP, p<0.0001); and, complication rates were less (1.7% TR vs. 5.1% Lap). Similar findings occurred with SG performed TR (operative time = 47.4 TR vs. 53.1 min LAP, p=0.01; LOS = 1.14 vs. 1.30 d, p<0.0001; and complication rates=0.8% vs. 3.2%). LOS was also shorter for the TR vs. LAP DS (1.25 vs. 1.58 d, p=0.01), but surgical approach was without effect on operative times and complications.

Conclusions

MBS performed totally robotic vs. LAP is associated with a faster rate of recovery (LOS), and, for the RYGB and SG, fewer complications and a shorter time in surgery.