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Introduction <p>A preponderance of studies demonstrates that longer operative times lead to poorer outcomes across surgical specialties and operative approaches. The objective of this study was to examine operative time trends and associated perioperative outcomes in robotic bariatric metabolic surgery compared to the laparoscopic approach.</p> Methods <p>Robotic (RA) and laparoscopic (L) sleeve gastrectomy (SG) and gastric bypass (RYGB) were compared using the 2015–2023 MBSAQIP data. A total of 467,954 patients were propensity score matched 1:1 (age, BMI, sex, comorbidities).</p> Results <p>Median operative times were significantly longer for both RA-SG (80 vs. 58&#xa0;min; p &lt; 0.01) and RA-RYGB (133 vs. 107&#xa0;min; p &lt; 0.01) compared with laparoscopic. Over the study period, the difference in median operative times for RA-RYGB vs. L-RYGB along with RA-SG vs. L-SG has decreased (p &lt; 0.01) but not continuously. Operative times for all groups have decreased significantly over the study period (p &lt; 0.01). For both RYGB and SG surgeries, the robotic groups had significantly higher rates of reoperation, readmission, reintervention, and emergency department (ED) visits within the 30-day perioperative window. There were no significant differences in mortality.</p> Conclusion <p>Despite a tenfold increase in annual robotic case volume over 8&#xa0;years, robotic bariatric operative times remain significantly longer in every year of MBSAQIP data (RA-SG + 28%, p &lt; 0.01; RA-RYGB + 18%, p &lt; 0.01). Longer operative times in the propensity-matched cases are associated with worse 30-day perioperative outcomes for the robotic groups (higher reoperation rates, readmissions, reinterventions, and ED visits). These data imply the surgical community is complicit in both the rising cost of healthcare and the exposure of patient harm despite no identifiable clinical benefit.</p>

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The longitudinal inefficiency of robotic bariatric surgery: can we finally agree we are over the learning curve and robotic bariatric surgery just takes longer?

  • 期刊论文

  • 发表日期：

    2025年10月20日

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  • Arash Rahimi-Ardabily,
  • Mark Kapran,
  • James Dove,
  • Justin Dhyani,
  • Osama Shaheen,
  • Mark E. Mahan,
  • Alexandra Falvo,
  • Ryan Horsley,
  • Vladan Obradovic,
  • Anthony T. Petrick,
  • David M. Parker

摘要

Introduction

A preponderance of studies demonstrates that longer operative times lead to poorer outcomes across surgical specialties and operative approaches. The objective of this study was to examine operative time trends and associated perioperative outcomes in robotic bariatric metabolic surgery compared to the laparoscopic approach.

Methods

Robotic (RA) and laparoscopic (L) sleeve gastrectomy (SG) and gastric bypass (RYGB) were compared using the 2015–2023 MBSAQIP data. A total of 467,954 patients were propensity score matched 1:1 (age, BMI, sex, comorbidities).

Results

Median operative times were significantly longer for both RA-SG (80 vs. 58 min; p < 0.01) and RA-RYGB (133 vs. 107 min; p < 0.01) compared with laparoscopic. Over the study period, the difference in median operative times for RA-RYGB vs. L-RYGB along with RA-SG vs. L-SG has decreased (p < 0.01) but not continuously. Operative times for all groups have decreased significantly over the study period (p < 0.01). For both RYGB and SG surgeries, the robotic groups had significantly higher rates of reoperation, readmission, reintervention, and emergency department (ED) visits within the 30-day perioperative window. There were no significant differences in mortality.

Conclusion

Despite a tenfold increase in annual robotic case volume over 8 years, robotic bariatric operative times remain significantly longer in every year of MBSAQIP data (RA-SG + 28%, p < 0.01; RA-RYGB + 18%, p < 0.01). Longer operative times in the propensity-matched cases are associated with worse 30-day perioperative outcomes for the robotic groups (higher reoperation rates, readmissions, reinterventions, and ED visits). These data imply the surgical community is complicit in both the rising cost of healthcare and the exposure of patient harm despite no identifiable clinical benefit.