• Annals of surgery · Oct 2023

    Impact of Robotic Assistance on Complications in Bariatric Surgery at Expert Laparoscopic Surgery Centers. A Retrospective Comparative Study With Propensity Score.

    • Robert Caiazzo, Pierre Bauvin, Camille Marciniak, Patrick Saux, Geoffrey Jacqmin, Raymond Arnoux, Salomon Benchetrit, Jerome Dargent, Jean-Marc Chevallier, Vincent Frering, Jean Gugenheim, David Lechaux, Simon Msika, Adrien Sterkers, Philippe Topart, Grégory Baud, François Pattou, and SOFFCO-mm Study Group.
    • General and Endocrine Surgery Department, Lille University Hospital CHU Lille, Lille.
    • Ann. Surg. 2023 Oct 1; 278 (4): 489496489-496.

    ObjectiveTo investigate the way robotic assistance affected rate of complications in bariatric surgery at expert robotic and laparoscopic surgery facilities.BackgroundWhile the benefits of robotic assistance were established at the beginning of surgical training, there is limited data on the robot's influence on experienced bariatric laparoscopic surgeons.MethodsWe conducted a retrospective study using the BRO clinical database (2008-2022) collecting data of patients operated on in expert centers. We compared the serious complication rate (defined as a Clavien score≥3) in patients undergoing metabolic bariatric surgery with or without robotic assistance. We used a directed acyclic graph to identify the variables adjustment set used in a multivariable linear regression, and a propensity score matching to calculate the average treatment effect (ATE) of robotic assistance.ResultsThe study included 35,043 patients [24,428 sleeve gastrectomy (SG); 10,452 Roux-en-Y gastric bypass (RYGB); 163 single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S)], with 938 operated on with robotic assistance (801 SG; 134 RYGB; 3 SADI-S), among 142 centers. Overall, we found no benefit of robotic assistance regarding the risk of complications (average treatment effect=-0.05, P =0.794), with no difference in the RYGB+SADI group ( P =0.322) but a negative trend in the SG group (more complications, P =0.060). Length of hospital stay was decreased in the robot group (3.7±11.1 vs 4.0±9.0 days, P <0.001).ConclusionsRobotic assistance reduced the length of stay but did not statistically significantly reduce postoperative complications (Clavien score≥3) following either GBP or SG. A tendency toward an elevated risk of complications following SG requires more supporting studies.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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