Current Status of Robotic Bariatric Surgery

A Systematic Review

Roberto Cirocchi; Carlo Boselli; Alberto Santoro; Salvatore Guarino; Piero Covarelli; Claudio Renzi; Chiara Listorti; Stefano Trastulli; Jacopo Desiderio; Andrea Coratti; Giuseppe Noya; Adriano Redler; Amilcare Parisi


BMC Surg. 2013;13(53) 

In This Article


A systematic literature search was performed on PubMed, Cochrane Central Register of Controlled Trials, BioMed Central and on Web of Science from January 2003 to November 2012. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) was followed 005B.[12] Additional file 1. The following search strategies were used in PubMed:

  • Robot-assisted [All Fields] AND ("bariatric surgery"[MeSH Terms] OR ("bariatric"[All Fields] AND "surgery"[All Fields]) OR "bariatric surgery"[All Fields])

  • Robot-assisted [All Fields] AND ("gastric bypass"[MeSH Terms] OR ("gastric"[All Fields] AND "bypass"[All Fields]) OR "gastric bypass"[All Fields] OR "roux en y gastric bypass"[All Fields]) Robot-Assisted[All Fields] AND Sleeve[All Fields] AND ("gastrectomy"[MeSH Terms] OR "gastrectomy"[All Fields])

  • ("robotics"[MeSH Terms] OR "robotics"[All Fields] OR "robotic"[All Fields]) AND ("bariatric surgery"[MeSH Terms] OR ("bariatric"[All Fields] AND "surgery"[All Fields]) OR "bariatric surgery"[All Fields])

  • ("robotics"[MeSH Terms] OR "robotics"[All Fields] OR "robotic"[All Fields]) AND ("Band"[Journal] OR "band"[All Fields])

All titles and abstracts were assessed to select those focusing on robotic bariatric surgery. Subsequently, the full-text of the selected trials were independently screened by two authors (RCand ST) for eligibility. When there was overlapping between multiple articles published by the same authors and no difference in the examined time, only the most recent trial was enclosed to avoid double counting. The Pubmed function "related articles" and Google Scholar database were used to search further articles. We also searched the online database of relevant high-impact journals such as Surgery for Obesity and Related Diseases, Obesity, Obesity review, International Journal of Obesity, Obesity Surgery and Surgical Endoscopy. The references of the included studies were evaluated for other potential trials. The two screening authors evaluated the eligibility of each trial.

Inclusion Criteria

In this systemic review, we considered both comparative and non-comparative studies, irrespectively of their size, publication status and language, which included patients who underwent robotic bariatric surgery . Comparative studies were included if they focused on selected outcomes of interest, irrespectively of the type of surgical approach used for comparative group (laparoscopic or open).

Exclusion Criteria

Studies in which the outcomes of interest were neither reported nor directly or indirectly inferable.

Data Extraction

Primary Outcomes. surgical (conversion to open surgery, anastomotic leakage, re-intervention for complications, mortality), bariatric (postoperative Body Mass Index), and metabolic (type 2 DM remission) outcomes were considered.

Secondary Outcomes.

  • Surgical ones (major and minor complication rate, pulmonary embolism rate, deep venous thrombosis, 30-days re-admission rate, anastomotic bleeding, gastrojejunostomy anastomotic stricture, post-operative small bowel obstruction, length of hospital stay, operative time).

  • metabolic ones (number of patients able to discontinue medical treatment for T2DM at the follow-up and other obesity related morbidities resolution or improvement such as hypertension, sleep apnoea, gastroesophageal reflux and degenerative arthritis).

The included CCT studies were assessed for their methodological quality using the revised and modified grading system of the Scottish Intercollegiate Guidelines Network (SIGN);[13] the case series assessment was carried out using the checklist for the quality of case series of the National Institute for Health and Clinical Excellence (NICE).[14] Two authors (RC and CR) independently extracted data for the listed outcomes and assessed the methodological quality of each study, without masking the authors' names.