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Background

Robotic surgery is an increasingly popular alternative to laparoscopy for performing bariatric operations. Our aim is to describe changes in utilization and complication rates of this technique over the last six years.

Methods

An analysis of the 2015-2020 MBSAQIP PUF was performed. All patients who underwent laparoscopic or robotic bariatric surgery from 2015-2020 were analyzed and patient demographics and outcomes compared.

Results

1,341,814 robotic and laparoscopic bariatric operations were included. Both the number and proportion performed robotically increased steadily from 2015 (n=9,866, 5.87%) to 2019 (n=54,356, 13.16%). In 2020, although the number of cases decreased, the proportion performed robotically still increased (17.37%). Robotic cases were also increasingly performed on high-risk patients with 77.06% of patients undergoing robotic bariatric surgery being ASA class 3 or higher in 2015 versus 81.03% (p=0.001) in 2020. Yet, over the same time period, there has been no significant change in risk of death within 30 days (p=0.946) or infection (p=0.721). In fact, the risk of any complication has decreased from 8.21% in 2015 to 6.43% in 2020 (P=0.001). These rates are comparable to conventional laparoscopy (5.55% in 2020, p=0.001) and the difference that is seen may be partially accounted for by the fact that robotic cases were more likely to be revision/conversion operations (12.16% vs 11.4%, p=0.001).

Conclusions

From 2015-2020 robotic bariatric surgery became more prevalent and yet, it remains a safe option, even in high-risk patients, with improving complication rates, which are comparable to conventional laparoscopy.