Robot-assisted revisional bariatric surgery

As more bariatric procedures are performed every year in the United States, the number of revisions has increased concomitantly. Most commonly indicated due to weight regain or insufficient weight loss, these operations are usually more challenging and tend to be associated with higher morbidity rates than primary surgery. Although technically demanding, revisional surgery offers additional weight management and improvement of obesity-related comorbidities. Enhanced visualization, improved range of motion and ergonomics, multi quadrant access, and motion scaling are all features that make robotic platforms potentially promising for complex operations such as revisional bariatric surgery. A robotic approach also reduces mechanical strain from thick abdominal walls and allows for easier hand-sewn anastomoses when the field of vision is limited. Benefits need to be contrasted by the known limitations of longer operative times (OTs), including docking, lack of haptic feedback, equipment costs, and the training needed to acquire expertise. So far, most studies do not show significant differences in outcomes between robot-assisted and laparoscopic approaches. Further advancement in the field and widespread use could likely bring costs down and improve patient outcomes when chosen judiciously. Overall, robot-assisted revisional bariatric surgery appears to be a safe and feasible alternative to laparoscopic revisional bariatric surgery (LRBS) for complex patients.