Impact of robotic assistance on complications in bariatric surgery at expert laparoscopic surgery centers. A retrospective comparative study with propensity score.
Robert Caiazzo*1, Pierre Bauvin2, Camille Marciniak1, Patrick Saux2, Gregory Baud1, Francois Pattou1
1Lille Univ Hospital, Lille, France; 2Lille Univ, Lille, France
Introduction :
In the United States, where the development of the surgical robot began, the adoption of this approach has been much slower in Europe, probably due to a long history of laparoscopic surgery. While the positive impact of robotic assistance has been demonstrated at the beginning of the surgical experience, there is little data on the impact of the robot in experienced bariatric laparoscopic surgeons and in the most complex patients.
Methods:
We conducted a retrospective study using the BRO clinical database (2015 - 2020) gathering patients operated in centers labeled or in the process of being labeled by the French Society of Bariatric Surgery and collecting patients' clinical characteristics and complications related to surgery until the 30th postoperative day. The following variables were included in the analysis: initial BMI, sex, presence of comorbidities, reoperation, ASA score, type of surgery, center experience, surgeon experience.
Complications were defined as a Clavien score ≥ 3. We compared the complication risk of 34,105 patients undergoing Sleeve Gastrectomy (SG), Roux-en-Y Gastric Bypass (RYGB) or SADI without robotic assistance, with 938 patients with robotic assistance. We used a DAG (Directed Acyclic Graph) to identify the variables adjustment set, used in a multivariable linear regression as well as a propensity score matching to calculate the Average Treatment Effect (ATE) of robotic assistance. Quantitative data are expressed as mean (standard deviation) and qualitative data as percentage (%).
Results
The analysis included 35,043 patients (24,428 SG, 10,452 RYGB and 163 SADI), with 938 operated with robotic assistance (801 SG, 134 RYGB and 3 SADI), among 142 centers with a mean annual number of surgeries of 72.6 (79.6). Overall, we found no benefit of robotic assistance regarding complications risk (ATE = -0.05, p-value = 0.794). When analyzing each operation separately (RYGB and SADI, or SG), we found no difference in the RYGB+SADI group (p-value = 0.322) but a negative trend in the SG group (more complications, p-value = 0.060). No difference were found when analyzing sub-population with higher complication risk: BMI ≥ 50 kg/m2, p-value = 0.944; BMI ≥ 40 kg/m2 and height ≤ 165 cm, p-value = 0.971 ; BMI ≥ 40 kg/m2 and height ≤ 165 cm or with diabetes, p-value = 0.947.
Conclusion
Robotic assistance did not provide a statistically significant decrease in postoperative complications (Clavien≥3) after either GBP or SG in our study including expert laparoscopic surgery centers. A trend towards an increased risk of complication after SG calls for further complementary investigations to be proposed.
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