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Laparoscopic Versus Robotic Roux-En-Y Gastric Bypass: Lessons and Long-Term Follow-Up Learned From a Large Prospective Monocentric Study

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Abstract

Background

Laparoscopic Roux-en-Y gastric bypass (RYGB) has become the procedure of choice for the treatment of morbid obesity. Recently, several reports have shown the potential advantages of the robotic approach, notably by reducing complications. The aim of this study is to report our long-term experience with robotic Roux-en-Y gastric bypass (RYGB) and to compare outcomes with the laparoscopic approach.

Methods

From January 2003 to September 2013, 777 consecutive minimally invasive RYGB have been performed in our institution: 389 laparoscopically (50.1 %) and 388 robotically (49.9 %). During the study period, all the data regarding these consecutive RYGB has been prospectively collected in a dedicated database.

Results

While longer in duration compared to laparoscopy (+30 min; p = 0.0001), the robotic approach had a lower conversion rate (0.8 vs. 4.9 %; p = 0.0007), and less complications (11.6 % vs. 16.7 %; p = 0.05), in particular, less gastrointestinal leaks (0.3 vs. 3.6 %; p = 0.0009). There were also less early reoperations (1 vs. 3.3 %; p = 0.05) and a shorter hospital stay in the robotic group (6.2 vs. 10.4 days; p = 0.0001). There were no statistical differences between the early and the current robotic experience, except in operative time and hospital stay, which were shorter for the last 100 cases. Finally, the BMI loss was significantly higher in the laparoscopic group starting at the first post-operative year.

Conclusions

Robotic RYGB is not only safe and feasible, but also a valid option in comparison to laparoscopy. At the cost of a longer operative time, we observed better short-term outcomes with the robotic approach.

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References

  1. Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg. 1994;4(4):353–7.

    Article  PubMed  Google Scholar 

  2. Powell MS, Fernandez AZ. Surgical treatment for morbid obesity: the laparoscopic Roux-en-Y gastric bypass. Surg Clin N Am. 2011;91(6):1203–24.

    Article  PubMed  Google Scholar 

  3. Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg. 2004;14(9):1157–64.

    Article  PubMed  Google Scholar 

  4. Schauer P, Conference ABSC. Gastric bypass for severe obesity: approaches and outcomes. Surg Obes Relat Dis. 2005;1(3):297–300.

    Article  PubMed  Google Scholar 

  5. Schauer PR, Ikramuddin S. Laparoscopic surgery for morbid obesity. Surg Clin N Am. 2001;81(5):1145–79.

    Article  CAS  PubMed  Google Scholar 

  6. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56.

    Article  PubMed  Google Scholar 

  7. Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.

    Article  PubMed  Google Scholar 

  8. Lee S, Carmody B, Wolfe L, et al. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3828 gastric bypass cases. J Gastrointest Surg. 2007;11(6):708–13.

    Article  PubMed  Google Scholar 

  9. Jones Jr KB, Afram JD, Benotti PN, et al. Open versus laparoscopic Roux-en-Y gastric bypass: a comparative study of over 25,000 open cases and the major laparoscopic bariatric reported series. Obes Surg. 2006;16(6):721–7.

    Article  PubMed  Google Scholar 

  10. Buchs NC, Addeo P, Bianco FM, et al. Perioperative risk assessment in robotic general surgery: lessons learned from 884 cases at a single institution. Arch Surg. 2012;147(8):701–8.

    Article  PubMed  Google Scholar 

  11. Tieu K, Allison N, Snyder B, et al. Robotic-assisted Roux-en-Y gastric bypass: update from 2 high-volume centers. Surg Obes Relat Dis. 2013;9(2):284–8.

    Article  PubMed  Google Scholar 

  12. Hagen ME, Pugin F, Chassot G, et al. Reducing cost of surgery by avoiding complications: the model of robotic Roux-en-Y gastric bypass. Obes Surg. 2012;22(1):52–61.

    Article  PubMed  Google Scholar 

  13. Ayloo SM, Addeo P, Buchs NC, et al. Robot-assisted versus laparoscopic Roux-en-Y gastric bypass: is there a difference in outcomes? World J Surg. 2011;35(3):637–42.

    Article  PubMed  Google Scholar 

  14. Snyder BE, Wilson T, Leong BY, et al. Robotic-assisted Roux-en-Y Gastric bypass: minimizing morbidity and mortality. Obes Surg. 2010;20(3):265–70.

    Article  PubMed  Google Scholar 

  15. Sanchez BR, Mohr CJ, Morton JM, et al. Comparison of totally robotic laparoscopic Roux-en-Y gastric bypass and traditional laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005;1(6):549–54.

    Article  PubMed  Google Scholar 

  16. Markar SR, Karthikesalingam AP, Venkat-Ramen V, et al. Robotic vs. laparoscopic Roux-en-Y gastric bypass in morbidly obese patients: systematic review and pooled analysis. Int J Med Robot. 2011;7(4):393–400.

    Article  CAS  PubMed  Google Scholar 

  17. Kim K, Hagen ME, Buffington C. Robotics in advanced gastrointestinal surgery: the bariatric experience. Cancer J. 2013;19(2):177–82.

    Article  PubMed  Google Scholar 

  18. Fourman MM, Saber AA. Robotic bariatric surgery: a systematic review. Surg Obes Relat Dis. 2012;8(4):483–8.

    Article  PubMed  Google Scholar 

  19. Swiss Study Group for Morbid Obesity (SMOB). Directives pour le traitement chirurgical de l'obésité. www.smob.ch 2010.

  20. Buchs NC, Pugin F, Bucher P, et al. Learning curve for robot-assisted Roux-en-Y gastric bypass. Surg Endosc. 2012;26(4):1116–21.

    Article  PubMed  Google Scholar 

  21. Buchs NC, Bucher P, Pugin F, et al. Value of performing routine postoperative liquid contrast swallow studies following robot-assisted Roux-en-Y gastric bypass. Swiss Med Wkly. 2012;142:w13556.

    PubMed  Google Scholar 

  22. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Deitel M, Greenstein RJ. Recommendations for reporting weight loss. Obes Surg. 2003;13(2):159–60.

    Article  PubMed  Google Scholar 

  24. Edelson PK, Dumon KR, Sonnad SS, et al. Robotic vs. conventional laparoscopic gastric banding: a comparison of 407 cases. Surg Endosc. 2011;25(5):1402–8.

    Article  PubMed  Google Scholar 

  25. Ayloo S, Buchs NC, Addeo P, et al. Robot-assisted sleeve gastrectomy for super-morbidly obese patients. J Laparoendosc Adv Surg Tech A. 2011;21(4):295–9.

    Article  PubMed  Google Scholar 

  26. Sudan R, Bennett KM, Jacobs DO, et al. Multifactorial analysis of the learning curve for robot-assisted laparoscopic biliopancreatic diversion with duodenal switch. Ann Surg. 2012;255(5):940–5.

    Article  PubMed  Google Scholar 

  27. Bailey JG, Hayden JA, Davis PJB, et al. Robotic versus laparoscopic Roux-en-Y gastric bypass (RYGB) in obese adults ages 18 to 65 years: a systematic review and economic analysis. Bailey Surg Endosc 2014;28:414–26.

  28. Hubens G, Balliu L, Ruppert M, et al. Roux-en-Y gastric bypass procedure performed with the da Vinci robot system: is it worth it? Surg Endosc. 2008;22(7):1690–6.

    Article  CAS  PubMed  Google Scholar 

  29. Mohr CJ, Nadzam GS, Curet MJ. Totally robotic Roux-en-Y gastric bypass. Arch Surg. 2005;140(8):779–86.

    Article  PubMed  Google Scholar 

  30. Buchs NC, Pugin F, Chassot G, et al. Robot-assisted Roux-en-Y gastric bypass for super obese patients: a comparative study. Obes Surg. 2013;23(3):353–7.

    Article  PubMed  Google Scholar 

  31. Snyder B, Wilson T, Woodruff V, et al. Robotically assisted revision of bariatric surgeries is safe and effective to achieve further weight loss. World J Surg. 2013;37(11):2569–73.

    Article  PubMed  Google Scholar 

  32. Buchs NC, Pugin F, Azagury DE, et al. Robotic revisional bariatric surgery: a comparative study with laparoscopic and open surgery. Int J Med Robot 2014;10:213–7.

  33. Artuso D, Wayne M, Grossi R. Use of robotics during laparoscopic gastric bypass for morbid obesity. JSLS. 2005;9(3):266–8.

    PubMed Central  PubMed  Google Scholar 

  34. Benizri EI, Renaud M, Reibel N, et al. Perioperative outcomes after totally robotic gastric bypass: a prospective nonrandomized controlled study. Am J Surg. 2013;206(2):145–51.

    Article  PubMed  Google Scholar 

  35. Curet MJ, Curet M, Solomon H, et al. Comparison of hospital charges between robotic, laparoscopic stapled, and laparoscopic hand-sewn Roux-en-Y gastric bypass. J Robot Surg. 2009;3:75–8.

    Article  Google Scholar 

  36. Myers SR, McGuirl J, Wang J. Robot-assisted versus laparoscopic gastric bypass: comparison of short-term outcomes. Obes Surg. 2013;23(4):467–73.

    Article  PubMed  Google Scholar 

  37. Park CW, Lam EC, Walsh TM, et al. Robotic-assisted Roux-en-Y gastric bypass performed in a community hospital setting: the future of bariatric surgery? Surg Endosc. 2011;25(10):3312–21.

    Article  PubMed  Google Scholar 

  38. Scozzari G, Rebecchi F, Millo P, et al. Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2011;25(2):597–603.

    Article  PubMed  Google Scholar 

  39. Baik SH, Kwon HY, Kim JS, et al. Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol. 2009;16(6):1480–7.

    Article  PubMed  Google Scholar 

  40. Abu Dayyeh BK, Lautz DB, Thompson CC. Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol. 2011;9(3):228–33.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Barbash GI, Glied SA. New technology and health care costs—the case of robot-assisted surgery. N Engl J Med. 2010;363(8):701–4.

    Article  CAS  PubMed  Google Scholar 

  42. Addeo P, Buchs NC. Robotic and laparoscopic gastric bypass: are they comparable? Surg Endosc. 2012;26(2):576–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Pascale Koutny-Fong, research nurse, for the data collection.

Conflict of Interest

Drs. Nicolas C. Buchs, Philippe Morel, Dan Azagury, Minoa Jung, Gilles Chassot, Olivier Huber, and François Pugin have no conflict of interest or financial ties to disclose. Monika E. Hagen has a financial relationship with Intuitive Surgical Inc.

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Authors and Affiliations

  1. Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland

    Nicolas C. Buchs, Philippe Morel, Dan E. Azagury, Minoa Jung, Gilles Chassot, Olivier Huber, Monika E. Hagen & François Pugin

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  1. Nicolas C. Buchs
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  2. Philippe Morel
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Correspondence to Nicolas C. Buchs.

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Buchs, N.C., Morel, P., Azagury, D.E. et al. Laparoscopic Versus Robotic Roux-En-Y Gastric Bypass: Lessons and Long-Term Follow-Up Learned From a Large Prospective Monocentric Study. OBES SURG 24, 2031–2039 (2014). https://doi.org/10.1007/s11695-014-1335-6

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