Robotic versus laparoscopic gastric bypass in bariatric surgery: a systematic review and meta-analysis on perioperative outcomes

Yit J Leang; Naveen Mayavel; Wilson T W Yang; Joseph C H Kong; Chrys Hensman; Paul R Burton; Wendy A Brown

doi:10.1016/j.soard.2023.08.007

Robotic versus laparoscopic gastric bypass in bariatric surgery: a systematic review and meta-analysis on perioperative outcomes

Surg Obes Relat Dis. 2024 Jan;20(1):62-71. doi: 10.1016/j.soard.2023.08.007. Epub 2023 Aug 16.

Authors

Yit J Leang¹, Naveen Mayavel², Wilson T W Yang², Joseph C H Kong³, Chrys Hensman³, Paul R Burton⁴, Wendy A Brown⁴

Affiliations

¹ Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia. Electronic address: yit.leang@monash.edu.
² Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia.
³ Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia.
⁴ Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia.

PMID: 37730445
DOI: 10.1016/j.soard.2023.08.007

Abstract

Background: Robotic-assisted surgery has emerged as a compelling approach to bariatric surgery. However, current literature has not consistently demonstrated superior outcomes to laparoscopic bariatric surgery to justify its higher cost. With its mechanical advantages, the potential gains from the robotic surgical platform are likely to be apparent in more complex cases such as gastric bypass, especially revisional cases.

Objective: This systematic review and meta-analysis aimed to summarize the literature and evaluate the peri-operative outcomes of patients with obesity undergoing robotic gastric bypass versus laparoscopic gastric bypass surgery.

Setting: Systematic review.

Methods: A literature search of Embase, Medline, Pubmed, Cochrane library, and Google Scholar was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing outcomes of robotic and laparoscopic gastric bypass for obesity were included.

Results: Twenty-eight eligible studies comprised a total of 82,155 patients; 9051 robotic bypass surgery (RBS) versus 73,104 laparoscopic bypass surgery (LBS) were included. All included studies compared Roux-en-Y gastric bypass. RBS was noted to have higher reoperation rate within 30 days (4.4% versus 3.4%; odds ratio 1.31 [95% CI, 1.04-1.66]; P = .027; I² = 43.5%) than LBS. All other endpoints measured (complication rate, anastomotic leak, anastomotic stricture, surgical site infections, hospital readmission, length of stay, operative time, conversion rate and mortality) did not show any difference between RBS and LBS.

Conclusion: This systematic review and meta-analysis showed that there was no significant difference in key outcome measures in robotic versus laparoscopic gastric bypass. RBS was associated with a slightly higher reoperation rate and there was no reduction in overall complication rate with the use of robotic platform.

Keywords: Clinical outcomes; Laparoscopic surgery; Metabolic surgery; Minimally invasive surgery; Obesity; Robotic surgery.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Bariatric Surgery*
Gastric Bypass* / adverse effects
Humans
Laparoscopy* / adverse effects
Obesity / surgery
Obesity, Morbid* / etiology
Obesity, Morbid* / surgery
Retrospective Studies
Robotic Surgical Procedures* / adverse effects
Treatment Outcome