Five Year Trends in the Utilization of Robotic Bariatric Surgery Procedures, United States 2015-2019

• Use of robotic bariatric surgery more than doubled, from 6.2% of operations in 2015 to 13.5% in 2019.
• Patients having robotic surgery were older, heavier and had more health conditions.
• After adjusting for these differences, robotic operations took 26 to 38 minutes longer and had more 30-day interventions and readmissions than laparoscopic operations.
• The study shows that robotic surgery has not yet been proven superior to laparoscopy for routine bariatric operations.

Why This Study Was Needed

Robotic platforms have spread rapidly in bariatric surgery, but whether they produce better results than standard minimally invasive (laparoscopic) surgery had not been rigorously tested on a national scale.

How the Study Was Done

The team analyzed 775,258 operations in the national MBSAQIP registry from 2015 to 2019, tracking how often robotic surgery was used and comparing 30-day outcomes with laparoscopic surgery after adjusting for differences between patients.

What the Study Found

• Robotic surgery grew from 6.2% of bariatric operations in 2015 to 13.5% in 2019.
• Robotic patients were older, had a higher BMI and were more likely to have 12 different health conditions.
• After adjustment, robotic operations took 26 to 38 minutes longer and had higher rates of 30-day interventions and readmissions.

What This Means for Patients

Robotic surgery is a valuable tool, particularly for complex revisional surgery and some challenging anatomy, but for most routine bariatric operations it has not been shown to be better than laparoscopy. The surgeon’s experience matters more than the platform. Read about what happens in the operating room.

Clinical Pearls

• Robotic bariatric surgery use more than doubled in five years.
• National data did not show better 30-day outcomes with robotics; readmissions and interventions were higher.
• Patient selection and surgeon experience may explain part of the difference.

Strengths and Limitations

The study is large and national. It covers only 30-day outcomes, cannot account for each surgeon’s learning curve, and robotic cases may have been more complex in ways the registry does not capture. This work was a finalist for an early investigator award at ObesityWeek 2021.

Expert Commentary

I use robotic, laparoscopic and endoscopic approaches, and I choose based on the patient and the operation, not the technology. This study is a useful reality check: a robot does not automatically make surgery better. In experienced hands it is an excellent tool for the right case.

— Dr. Nestor de la Cruz-Muñoz