title: Laparoscopic versus robotic Roux-en-Y gastric bypass: lessons and long-term follow-up learned from a large prospective monocentric study.
abstract: BACKGROUND
  Laparoscopic Roux-en-Y gastric bypass (RYGB) has become the procedure of choice for the treatment of morbid obesity. Recently, several reports have shown the potential advantages of the robotic approach, notably by reducing complications. The aim of this study is to report our long-term experience with robotic Roux-en-Y gastric bypass (RYGB) and to compare outcomes with the laparoscopic approach.
  
  
  METHODS
  From January 2003 to September 2013, 777 consecutive minimally invasive RYGB have been performed in our institution: 389 laparoscopically (50.1 %) and 388 robotically (49.9 %). During the study period, all the data regarding these consecutive RYGB has been prospectively collected in a dedicated database.
  
  
  RESULTS
  While longer in duration compared to laparoscopy (+30 min; p=0.0001), the robotic approach had a lower conversion rate (0.8 vs. 4.9 %; p=0.0007), and less complications (11.6 % vs. 16.7 %; p=0.05), in particular, less gastrointestinal leaks (0.3 vs. 3.6 %; p=0.0009). There were also less early reoperations (1 vs. 3.3 %; p=0.05) and a shorter hospital stay in the robotic group (6.2 vs. 10.4 days; p=0.0001). There were no statistical differences between the early and the current robotic experience, except in operative time and hospital stay, which were shorter for the last 100 cases. Finally, the BMI loss was significantly higher in the laparoscopic group starting at the first post-operative year.
  
  
  CONCLUSIONS
  Robotic RYGB is not only safe and feasible, but also a valid option in comparison to laparoscopy. At the cost of a longer operative time, we observed better short-term outcomes with the robotic approach.
authors: Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland, nicolas.c.buchs@hcuge.ch.
authors: Nicolas C
authors: NC
authors: Buchs
authors: Philippe
authors: P
authors: Morel
authors: Dan E
authors: DE
authors: Azagury
authors: Minoa
authors: M
authors: Jung
authors: Gilles
authors: G
authors: Chassot
authors: Olivier
authors: O
authors: Huber
authors: Monika E
authors: ME
authors: Hagen
authors: François
authors: F
authors: Pugin
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D012371:Robotics / Q000379:methods*