Laparoscopic versus robotic-assisted primary bariatric-metabolic surgery. Are we still expecting to overcome the learning curve? A propensity score-matched analysis of the MBSAQIP database.

Background Robotic surgery is becoming increasingly popular in bariatric-metabolic surgery. However, its superiority regarding postoperative outcomes compared to conventional laparoscopy has not been clearly proven. With growing adoption of robotic surgery and improved technologies, benefits should become more evident. Objectives Evaluate readmission and reoperation rates after bariatric-metabolic surgery performed by conventional laparoscopy versus robotic-assisted from 2015-2021. Setting Academic institution. Methods The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®) was reviewed for primary bariatric operations performed with conventional laparoscopy versus robotic-assisted. Postoperative outcomes were compared in a propensity score-matched sample. Results Of 1,065,272 cases meeting inclusion criteria, 926,437 (87%) were conventional laparoscopic bariatric-metabolic surgeries, which were matched 1:1 with robotic-assisted cases (138,835). Reoperation (OR(95% CI) 1.28(1.20-1.37), p<0.0001), postoperative morbidity (OR(95% CI) 1.19(1.13-1.25), p<0.0001), readmission (OR(95% CI) 1.21(1.17-1.26), p<0.0001), emergency room visits (OR(95% CI) 1.07(1.03-1.10), p<0.0001) and cumulative hospital stay >5 days (OR(95% CI) 1.14(1.08-1.21), p<0.0001) at 30 days postoperatively were significantly higher for robotic-assisted cases. The benefits of laparoscopic surgery over robotic-assisted surgery seem more evident in SG and BPD/DS than RYGB. Robotic-assisted cases had a similar mortality rate at 30 days postoperatively compared to conventional laparoscopic cases. Similar results were observed in cases from 2020-2021, except for emergency room visits, which showed no difference between groups. Conclusion Our results show a higher readmission and reoperation rate and higher morbidity at 30 days postoperatively in robotic-assisted bariatric-metabolic surgery compared to conventional laparoscopy. Analyzing only cases performed between 2020 and 2021, robotic surgery also does not show superiority over conventional laparoscopy.