Outcomes of totally robotic single-anastomosis duodenal–ileal bypass with sleeve gastrectomy: A large single-centre series

Abstract

BACKGROUND: In recent years, the robot surgical system begins to be applied in single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S). However, only a few studies with very small sample size are present on robotic SADI-S. OBJECTIVE: This retrospective study aimed to estimate the outcomes of totally robotic SADI-S. METHODS: 102 consecutive patients undergoing totally robotic SADI-S between March 2020 and December 2021 were included. Patient demographics, operative time, length of postoperative hospital stay, complications, conversion to laparotomy, reoperation, readmission, mortality, and postoperative weight loss were recorded to analyze the safety, effectiveness, and learning curve of totally robotic SADI-S. Based on the operative time, we evaluated the learning curve of robotic SADI-S by the cumulative sum (CUSUM) method. RESULTS: The overall follow-up rate was 100%. The mean operative time was 186.13 ± 36.91 min. Short-term (≤30 days) complication was present in 6.9% (n = 7), of which major complications were identified in 2.9% (n = 3), including 2 gastric leakages and 1 postoperative acute respiratory failure. None of the patients experienced a long-term (＞30 days) complication. No conversion to laparotomy or deaths occurred during the study period. The mean percent of total weight loss (%TWL) at 3, 6, 12 and 24 months was 21.87 ± 4.44%, 32.49 ± 5.31%,40.86 ± 7.84%, and 44.64 ± 5.88%, respectively. The mean percent of excess weight loss (%EWL) at 3, 6, 12 and 24 months was 52.78 ± 16.99%,76.53 ± 17.99%,95.22 ± 18.59%, and 113.74 ± 23.30%, respectively. The cumulative sum (CUSUM) of operative time reached the first peak when the number of cases accumulated to the 16th case, then reached the second peak and continued to decline when the number of cases accumulated to the 27th case. Subsequently, all the patients were classified into the learning stage group (the first 27 patients) and the mastery stage group (the last 75 patients). Except for operative time, proportion of abdominal drainage tubes and lengths of postoperative hospital stay, there was no significant difference between the learning stage and mastery stage groups. CONCLUSION: Totally robotic SADI-S seems to be feasible and effective in the treatment of morbid obesity, just like laparoscopic SADI-S. The learning curve of robotic SADI-S is 27 cases.