Comparative Safety of Robotic Versus Laparoscopic Bariatric Surgery.

Abstract

To determine the uptake of robotic-assisted bariatric surgery and evaluate its safety compared to the laparoscopic approach. Use of the robotic-assisted platform for bariatric surgery is increasing, however its comparative safety relative to the laparoscopic approach is unclear. This retrospective cohort study included adult patients in a national Medicare claims database who underwent bariatric surgery from January 1, 2012 to December 31, 2020. Instrumental variables analysis was used to assess risk-adjusted outcomes at 90 days, and 1, 3, 5, and 7 years after surgery. 121,521 patients (mean [SD] age 56.9 [11.7] years; 91,136 [75.0%] female) underwent bariatric surgery during the study period, of whom 74,993 (61.7%) underwent sleeve gastrectomy and 46,528 (38.3%) underwent gastric bypass. Use of robotic-assisted sleeve gastrectomy increased by 250%, from 5.1% to 17.9%, and use of robotic-assisted gastric bypass increased by 361%, from 4.2% to 19.3%. There were no significant differences in 90-day outcomes between the two approaches. At 7 years, there were no significant differences in the adjusted hazard ratio (aHR) of complications, hospitalization, emergency department use, reintervention, or revision between the two approaches. However, compared to the laparoscopic approach, the robotic-assisted approach was associated with a higher 7-year aHR of reoperation for both procedures (sleeve gastrectomy aHR 1.51 [95% CI 1.06-1.97]; gastric bypass aHR 1.58 [95% CI 1.12-2.03]). In this national cohort, use of robotic-assisted bariatric surgery more than tripled over the last decade, and short- and long-term outcomes were largely equivalent.