In recent years, the ability to use robotic technology in surgery has offered the opportunity to improve care. The use of this technology—during which a surgeon controls a robot that performs the procedure, instead of performing the procedure himself or herself—can lead to improved visualization and more precision. The technology is expensive, however, and it is unclear whether the high cost is worth the benefits.
In a study by researchers including IU School of Medicine’s Dimitrios Stefanidis, MD, PhD, recently published in Springer, surgeons attempted to look at how the outcomes from robotic surgery compared to those of more traditional surgery—in this case a Roux-en-Y gastric bypass surgery.
In the human body, food enters the stomach through the esophagus and then passes into the small intestine. There, most calories and nutrients are extracted. Later, food passes into the large intestine, and what remains is excreted as waste. The Roux-en-Y bypass cuts off most of the stomach, so that what remains is a small pouch connected to the esophagus. This small pouch is then connected directly to the small intestines (at the Roux limb) to form a Y-shape.
This robotic gastric bypass procedure makes it easier to feel full (as your stomach is much smaller). It also leads to fewer calories being absorbed, as the food bypasses some of the stomach and small intestine.
Researchers collected data for all the Roux-en-Y bypass surgeries conducted by one surgeon between 2007 and 2015. Some of these procedures were performed by hand (specifically laparoscopically) and some of them robotically. The transition from one procedure to the other occurred in 2011. The outcomes of interest included the length of the operation, how much blood was lost, the length of hospital stay, morbidity and mortality after the procedure, and percent excess weight loss at one year follow-up.
Of the 246 patients studied, 125 had a robotic gastric bypass procedure and 121 had a traditional procedure. Although patients in the robotic group tended to be heavier and older, they achieved a similar percentage of weight loss at one year. Robotic procedures took longer to perform, but patients went home earlier from the hospital. The robotic procedure also led to fewer overall complications and fewer severe complications.
Granted, this isn’t a controlled study, and it’s a study of one surgeon. But it’s useful data showing the potential for robotic gastric bypass surgery to improve length of stay (which can affect health care spending) and the incidence of complications. The actual cost-effectiveness of the procedure and its ability to affect patient-centered outcomes warrant further investigations.
Photo: Indiana University Health clinicians perform a surgical procedure with the assistance of robotics. (IU Health/Mike Dickbernd)