Impact of Robotic Assistance on Complications in Bariatric Surgery at Expert Laparoscopic Surgery Centers A Retrospective Comparative Study With Propensity Score

Objective: To investigate the way robotic assistance affected rate of complications in bariatric surgery at expert robotic and laparoscopic surgery facilities. Background: While the benefits of robotic assistance were established at the beginning of surgical training, there is limited data on the robot's influence on experienced bariatric laparoscopic surgeons. Methods: We conducted a retrospective study using the BRO clinical database (2008-2022) collecting data of patients operated on in expert centers. We compared the serious complication rate (defined as a Clavien score >= 3) in patients undergoing metabolic bariatric surgery with or without robotic assistance. We used a directed acyclic graph to identify the variables adjustment set used in a multivariable linear regression, and a propensity score matching to calculate the average treatment effect (ATE) of robotic assistance. Results: The study included 35,043 patients [24,428 sleeve gastrectomy (SG); 10,452 Roux-en-Y gastric bypass (RYGB); 163 single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S)], with 938 operated on with robotic assistance (801 SG; 134 RYGB; 3 SADI-S), among 142 centers. Overall, we found no benefit of robotic assistance regarding the risk of complications (average treatment effect=-0.05, P= 0.794), with no difference in the RYGB+SADI group (P= 0.322) but a negative trend in the SG group (more complications, P= 0.060). Length of hospital stay was decreased in the robot group (3.7 +/- 11.1 vs 4.0 +/- 9.0 days, P< 0.001). Conclusions: Robotic assistance reduced the length of stay but did not statistically significantly reduce postoperative complications (Clavien score >= 3) following either GBP or SG. A tendency toward an elevated risk of complications following SG requires more supporting studies.