Background

Diabetes increases surgical risk for MBS patients. In this study we have examined the effects of totally robotic (TR) versus laparoscopic (LAP) surgery on peri- and 30-day postoperative surgical outcomes of MBS patients with Type 2 diabetes (T2D).

Methods

Totally robotic (TR) and laparoscopic (LAP) Roux-en-Y gastric bypass (RYGB, n=351) and sleeve gastrectomy (SG, n=393) were performed by a single surgeon between January 9, 2020 and December 1, 2023. Among the surgeries performed, 275 were LAP and 469 TR. T2D incidence for all patients was 28% (RYGB=29%, SG=27%). Outcome measurements included1) patient characteristics (age, weight, BMI, co-morbidities, gender and 2) peri- and postoperative surgery outcomes, i.e. operative time, length of hospital stay (LOS), 30-day readmissions, reoperations, complications.

Results

Patients with T2D, as compared to those without, were significantly older (49.0 vs. 42.9 y), more likely to be male (31% vs. 23%) and had a higher number of preoperative co-morbidities (4.0 vs. 2.2, p<0.0001). With the LAP approach, patients with T2D vs. non-diabetes had significantly higher operative times (79.1 vs. 73.4 min, p=0.03), LOS (1.31 vs. 1.20 d, p=0.0015) and major complications (8.3% vs. 2.6%). The TR approach significantly (p<0.01) reduced operative times and LOS for patients with and without T2D and to comparable levels. Complication rates with the TR declined from 8.3% LAP to 2.4% TR for patients with T2D and 2.6% LAP to 0.9% TR for those without.

Conclusions

Surgical outcomes are improved with the totally robotic system over conventional laparoscopy for patients with T2D.