Pros and Cons of Robotic Revisional Bariatric Surgery

Abstract

<b><i>Introduction:</i></b> Revisional procedures in bariatric surgery are regarded as technically more demanding and riskier than primary interventions. While the use of the surgical robot has not yet proven to be advantageous in primary bariatric interventions, the question remains whether its use is justified for more complex revisional procedures. <b><i>Objective:</i></b> To show that revisional bariatric surgery can be performed safely using the da Vinci® Xi surgical system. <b><i>Methods:</i></b> We performed a retrospective analysis of prospectively recorded data for revisional bariatric procedures between January 2016 and November 2019. <b><i>Results:</i></b> Of 78 revision operations, four (5.1%) were performed by open surgery, 30 (38.5%) by laparoscopic surgery, and 44 (56.4%) by robotic surgery. A comparative analysis of robotic (<i>n</i> = 41) versus laparoscopic (<i>n</i> = 18) revisional Roux-en-Y gastric bypasses (rRYGB) revealed significant differences favoring the robotic approach for operative time (130.7 vs. 167.6 min), C-reactive protein values at days 1 (27.9 vs. 49.1 mg/L) and 2 (48.2 vs. 83.6 mg/L) after surgery, and length of stay (4.9 vs. 6.2 days). Lower complication rates (Clavien-Dindo II–V) were found after rRRYGB (7.3 vs. 22.2%, not significant). <b><i>Conclusions:</i></b> Revisional bariatric surgery using a robotic system is safe. The operative time performing rRRYGB is significantly shorter than rLRYGB in our experience. Otherwise, results were largely comparable. Due to different indications, different index operations and a wide range of revisional procedures, further studies are necessary to confirm these results.