Background

The use of robotic-assisted bariatric surgery is growing. The optimal approach to minimize complications remains unclear. We compare outcomes for robotic and laparoscopic bariatric surgery cases over an eight-year period using the MBSAQIP database.

Methods

Analysis of the MBSAQIP database was performed on patients who underwent primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) from 2015 to 2022. Revisions, conversions, cases converted to another approach, and combined cases were excluded. 30-day outcomes for robotic and laparoscopic cases were compared. T-test was used for continuous variables and chi-square test for categorical variables with p < 0.05 considered significant.

Results

855,046 patients were identified (619,320 SG; 235,726 RYGB). From 2015 to 2022, the percentage of SG and RYGB performed robotically increased from 6.7% and 6.4% to 29.5% and 31.8% respectively. Robotic SG and RYGB operative times were significantly longer than laparoscopic (SG : 88.1 +- 38.4 vs 64.4 +- 32.5 min; RYGB: 147.3 +- 57.5 vs 113.3 +- 50.3 min, p < 0.001). Robotic SG had a significantly higher risk of postoperative leak (0.19% vs 0.14%, p < 0.001) and GI bleeding (0.27% vs 0.21%, p = 0.01). Robotic RYGB had a significantly higher risk of readmission (5.4% vs 5.1%, p < 0.01) and lower GI bleeding risk (0.62% vs 0.75%, p < 0.05) without difference in leak rate (0.3% vs 0.3%).

Conclusions

This analysis demonstrates that robotic SG has higher complication rates and longer operative times compared to laparoscopic. Further studies are warranted to elucidate the factors driving these findings.