Robotic Bariatric Surgery in Patients with BMI > 50 kg/m 2 (Obesity V): A Systematic Review and Meta-Analysis

Purpose: Bariatric surgery poses a challenge in patients with BMI > 50 kg/m 2 . The current literature lacks sufficient data comparing robot-assisted and laparoscopy in this population. This systematic review aims to evaluate the effectiveness and safety of robotic bariatric surgery in patients with a BMI > 50 kg/m 2 . Methods: PubMed, Cochrane Central and EMBASE were searched for studies comparing robotically-assisted and laparoscopic bariatric surgery in patients with BMI > 50 kg/m 2 from inception until May 2024. We included all robotic bariatric techniques as the intervention group. Studies lacking control groups or having overlapping populations were excluded. Our outcomes were mean operative time, postoperative and intraoperative complications, reoperation, conversion to open, surgical site infection, anastomotic leak, length of hospital stay (LOS), and mortality. Results: From 163 initial results, 9 studies comparing laparoscopy and robotic approaches were included in our final analysis. Our sample comprised 149.047 patients, of whom 10,761 (7.2%) were submitted to robotic surgery. The mean BMI of the population ranged from 53.4 to 65.9 kg/m 2 . The robot platform use significantly increased the operative time (MD = 31.9 minutes; 95% CI: 2.8; 61; P = .032). However, there were no statistically significant differences observed in: postoperative or intraoperative complications (RR = 1.3; 95% CI: 0.4; 4.1; P = .6) and RR = 0.4; 95% CI: 0.04; 4.46; P = .4); reoperation rates (RR = 0.9; 95% CI: 0.4; 1.9; P = .8); conversion to open (RR = 0.8; 95% CI: 0.2; 3.6; P = .8); surgical site infection (RR = 1.1; 95% CI: 0.8; 1.6; P = .5); anastomotic leak (RR = 0.9; 95% CI: 0.09; 9.1; P = .9); length of hospital stay (MD = −0.07; 95% CI: −0.6; 0.4; P = .7) and mortality (RR = 0.7; 95% CI: 0.3; 1.7; P = .4). Conclusion: Our analysis supports the feasibility and safety of robotic platforms for bariatric procedures in patients with BMI > 50 kg/m 2 . Future prospective studies should prioritize investigating long-term outcomes and cost-effectiveness to enhance clinical decision-making for this patient demographic.