IBC Oxford University Oral Abstract 23 - Offsetting the high surgical risks of type 2 diabetes with totally robotic surgery
Authors: Smith D , Buffington C , Lopez C , Krzyzanowski S , Santos C 
Published: February 2025

Abstract

Introduction
Individuals with diabetes have an increased risk for adverse events when undergoing metabolic bariatric surgery (MBS). In this study, we examined the effects of totally robotic (ROB) versus laparoscopic (LAP) MBS on early postoperative surgical outcomes of patients with Type 2 diabetes (T2D) and compared these to outcomes of patients without diabetes (non-T2D).

Methods
The study design was retrospective and included 774 MBS patients, 211 (28%) of whom had T2D and 533 who did not. Among the surgeries, 49% were Roux-en-Y gastric bypass (RYGB) and 51% sleeve gastrectomy (SG), with 35% of surgeries performed LAP and 65% ROB. T2D was diagnosed among 29% of RYGB patients and 28% of those having a SG. Outcome measures were: 1) patient characteristics (age, weight, BMI, and co-existing health issues), 2) operative (op) times, 3) length of hospital stay (LOS), and 4) early (30-day) surgical outcomes, i.e., readmissions, reops, and major complications. All surgeries, LAP and ROB, were performed by a single surgeon.

Results
Characteristics between patients having a ROB or LAP procedure did not significantly differ. However, patients with T2D, as compared to their non-T2D cohort, were older (49.0 versus 42.9 y, P &lt; 0.0001), more likely to be male (31% versus 23% of population, P &lt; 0.02), and had a significantly greater number of co-existing health issues (4.0 versus 2.2, P &lt; 0.0001), including obstructive sleep apnoea, hypertension, dyslipidaemia, and cardiac issues. With conventional laparoscopy, op times for patients with T2D were significantly longer than for patients without diabetes, that is 90.5 versus 75.2 min, P &lt; 0.01. With the ROB platform, op times for patients with T2D were lower than when performed LAP (71.0 min ROB versus 90.5 min LAP, P &lt; 0.01) and comparable to those of patients without diabetes (75.5 min). Duration of the hospital stay (LOS) with the LAP approach for patients with T2D was significantly longer than for patients without T2D (1.48 versus 1.28 d, P &lt; 0.01). The ROB system significantly (P &lt; 0.01) reduced LOS for both patient groups and to comparable durations (1.19 d T2D and 1.16 d Non-T2D). With the LAP approach patients with T2D had a higher incidence of 30-d readmissions, reops, and major complications than did patients without T2D (30-d readmissions = 8.3% versus 6.7%, reops = 5.5% versus 0.5%, major complications = 8.3% versus 2.6%). With the ROB platform, 30-d outcomes were significantly improved over those of conventional laparoscopy for patients with or without T2D. For patients with T2D, 30-d readmission rates were 4.8% ROB versus 8.3% LAP, reops 1.6% ROB versus 5.5% LAP, and major complications 2.4% ROB versus 8.3% LAP. For patients without diabetes, 30-d readmission rates were 3.5% ROB versus 6.7% LAP, reops 0.2% ROB versus 0.5% LAP, and major complications 0.9% ROB versus 2.6% LAP.

Conclusions
For patients with T2D, surgical outcomes are improved with the totally ROB approach to rival those of patients without diabetes. Such improvements occur among patients with T2D despite their greater operative risk of the disease, older age and higher number of co-existing health issues. The findings suggest that the totally ROB approach to MBS may offset the elevated surgical risks of T2D.