Transitioning From Laparoscopic to Robotic Bariatric Surgery: A Surgeon-Centered Analytic Approach.

INTRODUCTION

Robotic assistance is increasingly adopted by bariatric surgeons with extensive laparoscopic experience. Evidence from pooled data, however, does not help individual surgeons determine whether transitioning to a robotic practice improves outcomes.

METHODS

In this retrospective cohort study, we analyzed bariatric procedures performed at 13 centers in the Pacific Northwest between 2011 and 2024. Surgeon-specific laparoscopic learning curves were modeled to estimate expected outcomes for robotic cases had they been performed laparoscopically. Observed robotic outcomes were then compared with these expectations to isolate the effect of robotic adoption. The study had > 80% power to detect an absolute difference in complication rates of approximately 1% point at a two-sided α of 0.05.

RESULTS

Among 22,914 bariatric procedures, 64.0% were laparoscopic and 34.8% robotic. Robotic utilization increased from 5.6% in 2011 to 66.2% in 2024. In unadjusted analyses, robotic gastric bypass was associated with lower surgical complication rates compared with laparoscopic gastric bypass (0.55% vs. 1.70%; P < 0.01). Four surgeons transitioned to a predominantly robotic practice (> 95% robotic after ≥ 300 laparoscopic cases), contributing 4,048 cases. Compared with expected complication rates modeled from continued laparoscopic performance, adjusted analysis showed that observed surgical complications after robotic adoption were not significantly different (absolute difference - 0.71%; 95% CI - 2.35 to 0.93). No significant differences were observed in systemic complications (- 0.44%; 95% CI - 1.78 to 0.89), 30-day readmission (- 0.55%; 95% CI - 1.52 to 0.43), or length of stay (- 0.16 days; 95% CI - 0.54 to 0.21).

CONCLUSIONS

Among experienced laparoscopic bariatric surgeons, improvements in outcomes after robotic adoption were attributable to ongoing skill maturation rather than the new technological platform.

KEY POINTS: • Robotic bariatric surgery adoption rose from 6% in 2011 to 66% in 2024. • Laparoscopic surgeons' outcomes improved steadily with accumulating experience. • Robotic adoption did not independently reduce complications or readmissions. • Improvements after robotics mirrored ongoing laparoscopic skill maturation.