Three Hundred Four Robotically Assisted Biliopancreatic Diversion with Duodenal Switch Operations with Gradual Robotic Approach Implementation: Short-Term Outcomes, Complication Profile, and Lessons Learned.

Setting: Community, academic affiliated hospital.
Objectives: In the recent years, a movement towards robotic-assisted biliopancreatic diversion with duodenal switch (BPD/DS) has reported mixed short-term outcomes. We report our 10-year experience with robotic-assisted BPD/DS in our institution.
Methods: We conducted a retrospective analysis of 304 consecutive bariatric patients who had robotic or robotic-assisted BPD/DS from December 2008 to February 2018 from a single operating surgeon. Thirty 30-day and 90-day complication and readmission rates were analyzed. No patient was lost to follow-up.
Results: The median age of the patients was 45 years (interquartile range (IQR) = 16; range = 20-72). Two hundred ten (69.1%) were female. The median pre-op body mass index (BMI) was 49.2 (IQR = 9; range = 34-79). Median operative time was 253.5 min (IQR = 61; range = 124-463). The median hospital length of stay (LOS) was 2 days (IQR = 2; range = 1-13). Thirty-day follow-up revealed 3 major and 20 minor events in 23 patients (7.6%) while there were 4 major and 7 minor events in 6 (2%) patients after 30 days. There were 15 (5%) readmissions within 30 days and 10 (3.2%) additional readmissions occurred past 30 days, but within 90-day period. A need for going back to operating room was observed in 4 (1.3%) patients within 30 days and an additional 5 (1.6%) needed an operation beyond 30 days, but within 90-day period. There was no anastomotic leak and no mortality recorded.
Conclusion: Robotic-assisted BPD/DS is safe with low early morbidity and mortality.