Total Robotic Metabolic and Bariatric Surgery Proves More Beneficial than Conventional Laparoscopy

According to the U.S. Centers for Disease Control and Prevention (CDC), 42.4% of Americans are affected by obesity. Research indicates that obesity can compromise the immune system, trigger chronic inflammation, and heighten the risk of several diseases and conditions including cardiovascular disease, stroke, type 2 diabetes, and certain cancers. Metabolic and bariatric surgeries, such as laparoscopic gastric bypass and sleeve gastrectomy, are recognized as the most effective and enduring treatments for severe obesity. These procedures not only lead to substantial and lasting weight loss but also improve or resolve related conditions such as type 2 diabetes, heart disease, and high blood pressure. The safety profile of these surgeries is comparable to that of some of the safest and most commonly performed surgeries in the U.S., such as gallbladder surgery, appendectomy, and knee replacement. The American Society for Metabolic and Bariatric Surgery (ASMBS) reports that in 2022, nearly 280,000 metabolic and bariatric procedures were conducted in the U.S., which is only about 1% of the eligible population based on BMI. Additionally, total robotic surgery is becoming increasingly significant in this field, offering new efficiencies and reduced complications for certain procedures and patients.

Now, two new studies presented at the ASMBS 2024 Annual Scientific Meeting have highlighted the potential advantages of total robotic metabolic and bariatric surgery, including shorter operative times, decreased lengths of hospital stay, and lower complication rates compared to laparoscopic approaches. In the first study, researchers from AdventHealth (Celebration, FL, USA) analyzed the outcomes of a single surgeon who conducted 809 metabolic and bariatric surgeries—498 totally robotic and 311 laparoscopic—between 2020 and 2023. They discovered that total robotic Roux-en-Y gastric bypass (RYGB) surgeries were associated with significantly shorter operative times (97.6 min vs. 115.4 min), shorter hospital stays (1.19 days vs. 1.39 days), and lower complication rates (1.7% vs. 5.1%) compared to conventional laparoscopy.

Similar advantages were observed in total robotic sleeve gastrectomy procedures, which required less operative time (47.4 min vs. 53.1 min), shorter hospitalization periods (1.14 days vs. 1.30 days), and fewer complications (0.8% vs. 3.2%). While the surgical approach to a duodenal switch did not affect operative times and complication rates, the total robotic approach did result in shorter hospital stays. These findings contrast with earlier meta-analyses and registry reports, which suggested that while robotic surgeries had similar outcomes to conventional laparoscopy, they tended to have longer operative times and higher costs. It is important to note that most surgeries in earlier reports were robot-assisted rather than fully robotic.

In a second study, the same researchers reported better outcomes and efficiencies in robotic procedures for patients with severe obesity and type 2 diabetes. Out of 744 patients, 469 underwent totally robotic and 275 underwent laparoscopic RYGB or sleeve gastrectomy. Patients with diabetes who underwent robotic surgery experienced lower major complication rates (2.4% vs. 8.3%), shorter hospital stays (1.19 days vs. 1.48 days), and reduced operative times (71.7 min vs. 90.5 min) compared to those who underwent laparoscopy, with outcomes similar to those of non-diabetic patients. The average preoperative BMI for these patients was 46.1.

“The robotic platform has advantages for patients with diabetes and high surgical risk,” said study co-author on both studies, Cynthia Buffington, PhD, researcher at AdventHealth. “Surgeons may achieve a higher level of precision, flexibility and control than is possible with conventional laparoscopy. This results in less tissue trauma, shorter recovery times, less opportunity for scarring, milder postoperative pain, and lower risk for infections and bleeds.”

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