IBC Oxford University Oral Abstract 29 - Totally robotic approach to primary metabolic surgery ameliorates postoperative bleeding

Abstract Introduction Postoperative bleeding is the most common major postoperative complication following metabolic bariatric surgery (MBS). The primary objective of the present study was to examine the incidence of postoperative bleeding among patients whose MBS procedure was performed totally robotic (ROB) and compare these rates to surgeries performed with conventional laparoscopy. Secondary endpoints of the study were peri-operative and early (30-d) postoperative surgical outcomes with the totally ROB versus laparoscopic (LAP) approach. Methods The study was a retrospective analysis of 809 (498 ROB, 311 LAP) primary surgeries performed by a single surgeon between 1/20–11/23, that is 351 Roux-en-Y gastric bypass (RYGB), 393 sleeve gastrectomy (SG), 65 duodenal switch (DS). All patients were under identical postoperative care and discharge protocols, and there were no significant differences in characteristics (age, BMI, total number of co-existing health issues) between patients who had a ROB or LAP approach. Outcome measures included: 1) incidence of major postoperative bleeding, 2) length of hospital stay (LOS), 3) operative (op) time, and 4) early (30-d) postoperative major complications, readmissions, and reoperations. Results Among surgeries performed laparoscopic, 71% of major complications were postoperative bleeds. Of these, 60% required reoperation and 30% endoscopic intervention. The incidence rate for major bleeding following surgeries performed laparoscopic averaged 2.3% for all primary procedures and 3.4%, 2.5%, and 5.6% for RYGB, SG, and DS, respectively. Conversely, with the ROB system, postoperative bleeding was rare. No postoperative bleeding occurred among patients having a ROB SG or DS and only 1 bleed occurred with the RYGB, a patient with multiple co-existing health issues and numerous adhesions prolonging surgery. Other surgical outcomes were also significantly improved with the ROB approach over conventional laparoscopy. For patients having a SG or RYGB, op times were significantly (P < 0.0001) lower when surgeries were performed ROB versus LAP. Length of hospital stay was also significantly (P < 0.0001) shorter following ROB procedures, i.e., all surgeries LOS = 1.18 d ROB versus 2.37 d LAP; RYGB = 1.19 d ROB versus 1.39 d LAP; SG = 1.14 d ROB versus 1.25 d LAP; DS = 1.25 ROB versus 1.58 d LAP. Readmission rates (30-d) were significantly less when surgeries were performed robotic (3.4% ROB versus 6.7% LAP), as were major complications (all surgeries = 1.2% ROB versus 4.0% LAP; RYGB = 1.7% ROB versus 5.1% LAP; SG = 0.85% ROB versus 3.2% LAP). Conclusions For primary MBS, the totally robotic approach results in highly significant reduction of postoperative bleeding, along with a decreased incidence of 30-d major complications, reops, readmissions and lower duration of surgery and length of hospital stay.