ArticleSurgical endoscopy2025
Robotic approach does not eliminate first assistant in bariatric surgery compared to laparoscopy.
Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Recent Advances in Metabolic and Bariatric Surgery: A Narrative Review of Therapeutic Strategies for Weight Loss and Metabolic Health.Diabetes, metabolic syndrome and obesity : targets and therapy · 2026Review
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Authors and funding
11 authors.
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Abstract
introductionLaparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) constitute the most commonly performed bariatric metabolic surgery (BMS) procedures in the USA. The number of robotic-assisted BMS cases remains low, primarily due to the increased cost and extended operative time associated with this technology. Our primary objective is to assess whether robotic platform reduces the need for a surgical first assistant (FA). Our secondary objective is to compare the utilization of skilled surgical assistants.
methodsWe conducted a retrospective analysis of the MBSAQIP Participant Use File cohort spanning from 2015 to 2019 to determine the prevalence of Attending Surgeon involvement in robotic-assisted, laparoscopic RYGB, and SG procedures, in comparison to non-physician surgical First Assistants. Cases involving medical trainees (residents and fellows) were excluded from the analysis. For each bariatric procedure, we established two distinct groups and employed propensity score matching to ensure patient comparability. A "good match" was defined as a standardized mean difference (SMD) of less than 0.10. All statistical analyses were two-sided, with a significance level set at P < 0.05.
resultsA total of 113,682 patients underwent LRYGB, with 12,480 undergoing robotic RYGB (RRYGB). After a 1:1 match, attending-level FAs were involved in 25.9% of LRYGB cases, mid-level FAs in 55.6%, and no assistants in 18.5%. In contrast, RRYGB cases utilized attending-level FAs in 13.7% of cases, mid-level FAs in 68.4%, and had no assistants in 17.9% of cases (P < 0.0001). In LSG, attending-level FAs were present in 28.1% of cases, mid-level FAs in 51.6%, and no assistants in 20.3%. In comparison, robotic SG (RSG) cases had attending-level FAs in 16.1%, mid-level FAs in 55.6%, and no assistants in 28.3% of cases (P < 0.0001).
conclusionThe robotic platform failed to show a reduction in the need for an assistant in Roux-en-Y Gastric Bypass (RYGB) procedures but did lead to a decrease in the number of assistants required in sleeve gastrectomy (SG). Mid-level assistance was necessary for the majority of robotic and laparoscopic bariatric metabolic cases. The robotic platform was associated with an approximate 12% reduction in the requirement for attending-level assistance in robotic procedures.
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