Safety and effectiveness of robotic <i>versus</i> laparoscopic Roux-en-Y gastric bypass for morbid obesity: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Lixia ^1,2 , YAO Liang ^2,3 , YAN Peijing ^2,4 , XIE Dongsheng ^2,5 , HAN Caiwen ^2,5 , GUO Tiankang ² , YANG Kehu ^2,4 ,  TIAN Limin ^2,6

1. Department of Ultrasonography, Gansu Provincial Hospital, Lanzhou 730000, P. R. China;
2. Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou 730000, P. R. China;
3. School of Chinses Medicine, Hong Kong Baptist University, Hong Kong 9990773, P. R. China;
4. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, P.R. China;
5. Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine 730000, P. R. China;
6. Department of Endocrinology, Gansu Provincial Hospital, Lanzhou 730000, P. R. China;

Corresponding?author：

TIAN Limin, Email: wlx815203@126.com

Keywords：

robotic; laparoscopic; Roux-en-Y gastric bypass; meta-analysis

DOI：

10.7507/1007-9424.201904097

Video：

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Objective To systematically review safety and effectiveness of robotic Roux-en-Y gastric bypass (RYGB) and laparoscopic RYGB for morbid obesity.Methods The systematic literatures were conducted by a comprehensive search in the PubMed, Embase, Cochrane Library, WanFang data, CNKI, and CBM, etc. Two reviewers independently selected the literatures and extracted the data. The meta-analysis was performed using the R statistical program version 3.4.2.Results A total of 19 studies involving 177 766 patients with morbid obesity were included, of which 172 234 underwent the laparoscopic RYGB (laparoscopic group) and 5 532 underwent the robotic RYGB (robotic group). The operative time was longer [MD=27.84, 95% CI (12.85, 42.83)] and the rate of death was higher [OR=2.05, 95% CI (1.03, 4.08)] in the robotic group as compared with the laparoscopic group. The hospitalization time, intraoperative blood loss, conversion rate, rates of reoperation and readmission of 30 d after the operation, and postoperative complications had no significant differences between these two groups.Conclusion Robotic RYGB is a safe and effective surgical procedure, but it is not found to be superior to laparoscopic RYGB.

Citation： WANG Lixia, YAO Liang, YAN Peijing, XIE Dongsheng, HAN Caiwen, GUO Tiankang, YANG Kehu, TIAN Limin. Safety and effectiveness of robotic versus laparoscopic Roux-en-Y gastric bypass for morbid obesity: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(11): 1311-1319. doi: 10.7507/1007-9424.201904097 Copy

1.	Abbasi A, Juszczyk D, van Jaarsveld CHM, et al. Body mass index and incident type 1 and type 2 diabetes in children and young adults: a retrospective cohort study. J Endocr Soc, 2017, 1(5): 524-537.
2.	Gallagher EJ, LeRoith D. Obesity and diabetes: the increased risk of cancer and cancer-related mortality. Physiol Rev, 2015, 95(3): 727-748.
3.	Lu JL, Molnar MZ, Naseer A, et al. Association of age and BMI with kidney function and mortality: a cohort study. Lancet Diabetes Endocrinol, 2015, 3(9): 704-714.
4.	Martin KA, Mani MV, Mani A. New targets to treat obesity and the metabolic syndrome. Eur J Pharmacol, 2015, 763(Pt A): 64-74.
5.	Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev, 2014, (8): CD003641.
6.	Sheng B, Truong K, Spitler H, et al. The long-term effects of bariatric surgery on type 2 diabetes remission, microvascular and macrovascular complications, and mortality: a systematic review and meta-analysis. Obes Surg, 2017, 27(10): 2724-2732.
7.	Kang JH, Le QA. Effectiveness of bariatric surgical procedures: A systematic review and network meta-analysis of randomized controlled trials. Medicine (Baltimore), 2017, 96(46): e8632.
8.	Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: A Joint Statement by International Diabetes Organizations. Surg Obes Relat Dis, 2016, 12(6): 1144-1162.
9.	Rausa E, Bonavina L, Asti E, et al. Rate of death and complications in laparoscopic and open Roux-en-Y gastric bypass. A meta-analysis and meta-regression analysis on 69 494 patients. Obes Surg, 2016, 26(8): 1956-1963.
10.	Bailey JG, Hayden JA, Davis PJ, et al. Robotic versus laparoscopic Roux-en-Y gastric bypass (RYGB) in obese adults ages 18 to 65 years: a systematic review and economic analysis. Surg Endosc, 2014, 28(2): 414-426.
11.	Economopoulos KP, Theocharidis V, McKenzie TJ, et al. Robotic vs. laparoscopic Roux-en-Y gastric bypass: a systematic review and meta-analysis. Obes Surg, 2015, 25(11): 2180-2189.
12.	Fourman MM, Saber AA. Robotic bariatric surgery: a systematic review. Surg Obes Relat Dis, 2012, 8(4): 483-488.
13.	Li K, Zou J, Tang J, et al. Robotic versus laparoscopic bariatric surgery: a systematic review and meta-analysis. Obes Surg, 2016, 26(12): 3031-3044.
14.	Markar SR, Karthikesalingam AP, Venkat-Ramen V, et al. Robotic vs. laparoscopic Roux-en-Y gastric bypass in morbidly obese patients: systematic review and pooled analysis. Int J Med Robot, 2011, 7(4): 393-400.
15.	Wells GA BS, O’Connell D, Peterson J, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. Available from: URL: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm [cited 2009 Oct 19].
16.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
17.	Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 2005, 5: 13.
18.	Ahmad A, Carleton JD, Ahmad ZF, et al. Laparoscopic versus robotic-assisted Roux-en-Y gastric bypass: a retrospective, single-center study of early perioperative outcomes at a community hospital. Surg Endosc, 2016, 30(9): 3792-3796.
19.	Ayloo SM, Addeo P, Buchs NC, et al. Robot-assisted versus laparoscopic Roux-en-Y gastric bypass: is there a difference in outcomes? World J Surg, 2011, 35(3): 637-642.
20.	Benizri EI, Renaud M, Reibel N, et al. Perioperative outcomes after totally robotic gastric bypass: a prospective nonrandomized controlled study. Am J Surg, 2013, 206(2): 145-151.
21.	Buchs NC, Morel P, Azagury DE, et al. Laparoscopic versus robotic Roux-en-Y gastric bypass: lessons and long-term follow-up learned from a large prospective monocentric study. Obes Surg, 2014, 24(12): 2031-2039.
22.	Celio AC, Kasten KR, Schwoerer A, et al. Perioperative safety of laparoscopic versus robotic gastric bypass: a propensity matched analysis of early experience. Surg Obes Relat Dis, 2017, 13(11): 1847-1852.
23.	Curet MJ, Curet M, Solomon H, et al. Comparison of hospital charges between robotic, laparoscopic stapled, and laparoscopic handsewn Roux-en-Y gastric bypass. J Robot Surg, 2009, 3(2): 75-78.
24.	Hubens G, Balliu L, Ruppert M, et al. Roux-en-Y gastric bypass procedure performed with the da Vinci robot system: is it worth it? Surg Endosc, 2008, 22(7): 1690-1696.
25.	Lyn-Sue JR, Winder JS, Kotch S, et al. Laparoscopic gastric bypass to robotic gastric bypass: time and cost commitment involved in training and transitioning an academic surgical practice. J Robot Surg, 2016, 10(2): 111-115.
26.	Mohr CJ, Nadzam GS, Curet MJ. Totally robotic Roux-en-Y gastric bypass. Arch Surg, 2005, 140(8): 779-786.
27.	Moon RC, Gutierrez JC, Royall NA, et al. Robotic Roux-en-Y gastric bypass, is it safer than laparoscopic bypass? Obes Surg, 2016, 26(5): 1016-1020.
28.	Myers SR, McGuirl J, Wang J. Robot-assisted versus laparoscopic gastric bypass: comparison of short-term outcomes. Obes Surg, 2013, 23(4): 467-473.
29.	Park CW, Lam EC, Walsh TM, et al. Robotic-assisted Roux-en-Y gastric bypass performed in a community hospital setting: the future of bariatric surgery? Surg Endosc, 2011, 25(10): 3312-3321.
30.	Sanchez BR, Mohr CJ, Morton JM, et al. Comparison of totally robotic laparoscopic Roux-en-Y gastric bypass and traditional laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis, 2005, 1(6): 549-554.
31.	Scozzari G, Rebecchi F, Millo P, et al. Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass. Surg Endosc, 2011, 25(2): 597-603.
32.	Smeenk RM, van’t Hof G, Elsten E, et al. The results of 100 robotic versus 100 laparoscopic gastric bypass procedures: a single high volume centre experience. Obes Surg, 2016, 26(6): 1266-1273.
33.	Snyder BE, Wilson T, Leong BY, et al. Robotic-assisted Roux-en-Y gastric bypass: minimizing morbidity and mortality. Obes Surg, 2010, 20(3): 265-270.
34.	Stefanidis D, Bailey SB, Kuwada T, et al. Robotic gastric bypass may lead to fewer complications compared with laparoscopy. Surg Endosc, 2018, 32(2): 610-616.
35.	Villamere J, Gebhart A, Vu S, et al. Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at Academic Medical Centers. Surg Endosc, 2015, 29(7): 1729-1736.
36.	Wood MH, Kroll JJ, Garretson B. A comparison of outcomes between the traditional laparoscopic and totally robotic Roux-en-Y gastric bypass procedures. J Robot Surg, 2014, 8(1): 29-34.
37.	Westphal D. Foreign experience in nursing: " Leonardo da Vinci” is promoting professional education in Europe. Pflege Z, 1999, 52(7): 498-500.
38.	夏澤鋒, 王清波, 帥曉明, 等. 達芬奇機器人輔助Roux-en-Y胃旁路術在肥胖癥治療中的應用價值. 中華肥胖與代謝病電子雜志, 2017, 3(1): 19-24.
39.	Chang SH, Freeman NLB, Lee JA, et al. Early major complications after bariatric surgery in the USA, 2003-2014: a systematic review and meta-analysis. Obes Rev, 2018, 19(4): 529-537.
40.	Froghi S, Ahmed K, Khan MS, et al. Evaluation of robotic and laparoscopic partial nephrectomy for small renal tumours (T1a). BJU Int, 2013, 112(4): E322-E333.
41.	Xiong J, Nunes QM, Tan C, et al. Comparison of short-term clinical outcomes between robotic and laparoscopic gastrectomy for gastric cancer: a meta-analysis of 2495 patients. J Laparoendosc Adv Surg Tech A, 2013, 23(12): 965-976.
42.	Khorgami Z, Aminian A, Shoar S, et al. Cost of bariatric surgery and factors associated with increased cost: an analysis of national inpatient sample. Surg Obes Relat Dis, 2017, 13(8): 1284-1289.
43.	Hagen ME, Pugin F, Chassot G, et al. Reducing cost of surgery by avoiding complications: the model of robotic Roux-en-Y gastric bypass. Obes Surg, 2012, 22(1): 52-61.
44.	Salman M, Bell T, Martin J, et al. Use, cost, complications, and mortality of robotic versus nonrobotic general surgery procedures based on a nationwide database. Am Surg, 2013, 79(6): 553-560.

1. Abbasi A, Juszczyk D, van Jaarsveld CHM, et al. Body mass index and incident type 1 and type 2 diabetes in children and young adults: a retrospective cohort study. J Endocr Soc, 2017, 1(5): 524-537.
2. Gallagher EJ, LeRoith D. Obesity and diabetes: the increased risk of cancer and cancer-related mortality. Physiol Rev, 2015, 95(3): 727-748.
3. Lu JL, Molnar MZ, Naseer A, et al. Association of age and BMI with kidney function and mortality: a cohort study. Lancet Diabetes Endocrinol, 2015, 3(9): 704-714.
4. Martin KA, Mani MV, Mani A. New targets to treat obesity and the metabolic syndrome. Eur J Pharmacol, 2015, 763(Pt A): 64-74.
5. Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev, 2014, (8): CD003641.
6. Sheng B, Truong K, Spitler H, et al. The long-term effects of bariatric surgery on type 2 diabetes remission, microvascular and macrovascular complications, and mortality: a systematic review and meta-analysis. Obes Surg, 2017, 27(10): 2724-2732.
7. Kang JH, Le QA. Effectiveness of bariatric surgical procedures: A systematic review and network meta-analysis of randomized controlled trials. Medicine (Baltimore), 2017, 96(46): e8632.
8. Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: A Joint Statement by International Diabetes Organizations. Surg Obes Relat Dis, 2016, 12(6): 1144-1162.
9. Rausa E, Bonavina L, Asti E, et al. Rate of death and complications in laparoscopic and open Roux-en-Y gastric bypass. A meta-analysis and meta-regression analysis on 69 494 patients. Obes Surg, 2016, 26(8): 1956-1963.
10. Bailey JG, Hayden JA, Davis PJ, et al. Robotic versus laparoscopic Roux-en-Y gastric bypass (RYGB) in obese adults ages 18 to 65 years: a systematic review and economic analysis. Surg Endosc, 2014, 28(2): 414-426.
11. Economopoulos KP, Theocharidis V, McKenzie TJ, et al. Robotic vs. laparoscopic Roux-en-Y gastric bypass: a systematic review and meta-analysis. Obes Surg, 2015, 25(11): 2180-2189.
12. Fourman MM, Saber AA. Robotic bariatric surgery: a systematic review. Surg Obes Relat Dis, 2012, 8(4): 483-488.
13. Li K, Zou J, Tang J, et al. Robotic versus laparoscopic bariatric surgery: a systematic review and meta-analysis. Obes Surg, 2016, 26(12): 3031-3044.
14. Markar SR, Karthikesalingam AP, Venkat-Ramen V, et al. Robotic vs. laparoscopic Roux-en-Y gastric bypass in morbidly obese patients: systematic review and pooled analysis. Int J Med Robot, 2011, 7(4): 393-400.
15. Wells GA BS, O’Connell D, Peterson J, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. Available from: URL: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm [cited 2009 Oct 19].
16. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
17. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 2005, 5: 13.
18. Ahmad A, Carleton JD, Ahmad ZF, et al. Laparoscopic versus robotic-assisted Roux-en-Y gastric bypass: a retrospective, single-center study of early perioperative outcomes at a community hospital. Surg Endosc, 2016, 30(9): 3792-3796.
19. Ayloo SM, Addeo P, Buchs NC, et al. Robot-assisted versus laparoscopic Roux-en-Y gastric bypass: is there a difference in outcomes? World J Surg, 2011, 35(3): 637-642.
20. Benizri EI, Renaud M, Reibel N, et al. Perioperative outcomes after totally robotic gastric bypass: a prospective nonrandomized controlled study. Am J Surg, 2013, 206(2): 145-151.
21. Buchs NC, Morel P, Azagury DE, et al. Laparoscopic versus robotic Roux-en-Y gastric bypass: lessons and long-term follow-up learned from a large prospective monocentric study. Obes Surg, 2014, 24(12): 2031-2039.
22. Celio AC, Kasten KR, Schwoerer A, et al. Perioperative safety of laparoscopic versus robotic gastric bypass: a propensity matched analysis of early experience. Surg Obes Relat Dis, 2017, 13(11): 1847-1852.
23. Curet MJ, Curet M, Solomon H, et al. Comparison of hospital charges between robotic, laparoscopic stapled, and laparoscopic handsewn Roux-en-Y gastric bypass. J Robot Surg, 2009, 3(2): 75-78.
24. Hubens G, Balliu L, Ruppert M, et al. Roux-en-Y gastric bypass procedure performed with the da Vinci robot system: is it worth it? Surg Endosc, 2008, 22(7): 1690-1696.
25. Lyn-Sue JR, Winder JS, Kotch S, et al. Laparoscopic gastric bypass to robotic gastric bypass: time and cost commitment involved in training and transitioning an academic surgical practice. J Robot Surg, 2016, 10(2): 111-115.
26. Mohr CJ, Nadzam GS, Curet MJ. Totally robotic Roux-en-Y gastric bypass. Arch Surg, 2005, 140(8): 779-786.
27. Moon RC, Gutierrez JC, Royall NA, et al. Robotic Roux-en-Y gastric bypass, is it safer than laparoscopic bypass? Obes Surg, 2016, 26(5): 1016-1020.
28. Myers SR, McGuirl J, Wang J. Robot-assisted versus laparoscopic gastric bypass: comparison of short-term outcomes. Obes Surg, 2013, 23(4): 467-473.
29. Park CW, Lam EC, Walsh TM, et al. Robotic-assisted Roux-en-Y gastric bypass performed in a community hospital setting: the future of bariatric surgery? Surg Endosc, 2011, 25(10): 3312-3321.
30. Sanchez BR, Mohr CJ, Morton JM, et al. Comparison of totally robotic laparoscopic Roux-en-Y gastric bypass and traditional laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis, 2005, 1(6): 549-554.
31. Scozzari G, Rebecchi F, Millo P, et al. Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass. Surg Endosc, 2011, 25(2): 597-603.
32. Smeenk RM, van’t Hof G, Elsten E, et al. The results of 100 robotic versus 100 laparoscopic gastric bypass procedures: a single high volume centre experience. Obes Surg, 2016, 26(6): 1266-1273.
33. Snyder BE, Wilson T, Leong BY, et al. Robotic-assisted Roux-en-Y gastric bypass: minimizing morbidity and mortality. Obes Surg, 2010, 20(3): 265-270.
34. Stefanidis D, Bailey SB, Kuwada T, et al. Robotic gastric bypass may lead to fewer complications compared with laparoscopy. Surg Endosc, 2018, 32(2): 610-616.
35. Villamere J, Gebhart A, Vu S, et al. Utilization and outcome of laparoscopic versus robotic general and bariatric surgical procedures at Academic Medical Centers. Surg Endosc, 2015, 29(7): 1729-1736.
36. Wood MH, Kroll JJ, Garretson B. A comparison of outcomes between the traditional laparoscopic and totally robotic Roux-en-Y gastric bypass procedures. J Robot Surg, 2014, 8(1): 29-34.
37. Westphal D. Foreign experience in nursing: " Leonardo da Vinci” is promoting professional education in Europe. Pflege Z, 1999, 52(7): 498-500.
38. 夏澤鋒, 王清波, 帥曉明, 等. 達芬奇機器人輔助Roux-en-Y胃旁路術在肥胖癥治療中的應用價值. 中華肥胖與代謝病電子雜志, 2017, 3(1): 19-24.
39. Chang SH, Freeman NLB, Lee JA, et al. Early major complications after bariatric surgery in the USA, 2003-2014: a systematic review and meta-analysis. Obes Rev, 2018, 19(4): 529-537.
40. Froghi S, Ahmed K, Khan MS, et al. Evaluation of robotic and laparoscopic partial nephrectomy for small renal tumours (T1a). BJU Int, 2013, 112(4): E322-E333.
41. Xiong J, Nunes QM, Tan C, et al. Comparison of short-term clinical outcomes between robotic and laparoscopic gastrectomy for gastric cancer: a meta-analysis of 2495 patients. J Laparoendosc Adv Surg Tech A, 2013, 23(12): 965-976.
42. Khorgami Z, Aminian A, Shoar S, et al. Cost of bariatric surgery and factors associated with increased cost: an analysis of national inpatient sample. Surg Obes Relat Dis, 2017, 13(8): 1284-1289.
43. Hagen ME, Pugin F, Chassot G, et al. Reducing cost of surgery by avoiding complications: the model of robotic Roux-en-Y gastric bypass. Obes Surg, 2012, 22(1): 52-61.
44. Salman M, Bell T, Martin J, et al. Use, cost, complications, and mortality of robotic versus nonrobotic general surgery procedures based on a nationwide database. Am Surg, 2013, 79(6): 553-560.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Safety and effectiveness of robotic versus laparoscopic Roux-en-Y gastric bypass for morbid obesity: a meta-analysis

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