Outcomes of totally robotic Roux-en-Y gastric bypass in patients with BMI ≥ 50 kg/m(2): can the robot level out “traditional” risk factors?

Roux-en-Y gastric bypass (RYGB) in patients with body mass index (BMI) ≥ 50 kg/m(2) is a challenging procedure and BMI ≥ 50 kg/m(2) has been identified as independent risk factor for postoperative complications and increased morbidity in previous studies. The objective of the present study was to assess whether a BMI ≥ 50 kg/m(2) and various established risk factors maintain their significance in patients undergoing fully robotic RYGB (rRYGB). A single-center analysis of prospectively collected data of 113 consecutive patients undergoing standardized rRYGB with robotic stapling technique and hand-sewn gastrojejunostomy using the daVinci Xi system. Surgical outcomes were analyzed considering a number of individual perioperative risk factors including BMI ≥ 50 kg/m(2). The mean BMI of the total cohort was 50.6 ± 5.5 kg/m(2) and 63.7% of patients had a BMI ≥ 50 kg/m(2). There were no major surgical and perioperative complications in patients with BMI ≥ 50 kg/m(2) as well as in those with BMI < 50 kg/m(2) after rRYGB. We identified female sex and surgeon experience but neither body weight, BMI, metabolic disorders, ASA nor EOSS scores as independent factors for shorter operation times (OT) in multivariate analyses. Complication rates and length of hospital stay (LOS) did not significantly differ between patients with potential risk factors and those without. rRYGB is a safe procedure in both, patients with BMI ≥ 50 kg/m(2) and with BMI < 50 kg/m(2). Higher body weight and BMI did affect neither OT nor LOS. A fully robotic approach for RYGB might help to overcome “traditional” risk factors identified in conventional laparoscopic bariatric surgery. However, larger and prospective studies are necessary to confirm these results.