Background: Robotic-assisted bariatric surgery has expanded rapidly, but its advantages over conventional laparoscopy remain uncertain. Methods: We compared 30-day outcomes after robotic versus laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) using the MBSAQIP 2020 to 2023 database. Patients undergoing primary SG or RYGB were propensity score matched using 22 preoperative variables. Results: Among 502,645 SG and 194,300 RYGB procedures, robotic SG was associated with higher rates of emergency department visits, blood transfusions, readmissions, venous thromboembolism, surgical site infections, and postoperative bleeding than laparoscopic SG. In contrast, robotic RYGB demonstrated lower rates of blood transfusions, surgical site infections, postoperative bleeding, and strictures than laparoscopic RYGB. Conclusions: Our findings suggest that robotic assistance was associated with procedure-specific differences in 30-day outcomes, with worse outcomes after SG but modestly improved outcomes after RYGB compared with laparoscopy.
Background and Aims: Unsedated colonoscopy often increases procedural pain and prolongs insertion time, especially in the sigmoid colon with acute luminal angulation. This study aimed to evaluate the efficacy and safety of preprocedural enhanced oral water intake (PWI) for unsedated colonoscopy. Methods: This randomized controlled trial (RCT) enrolled 372 eligible patients. They were randomized to the conventional air colonoscopy (CAC), water-assisted colonoscopy (WAC), and PWI groups to receive the assigned interventions. Primary outcomes included insertion time, visual analog scale (VAS), cecal intubation rate, bowel cleanliness, and adenoma detection rate (ADR). Results: All 3 groups achieved a cecal intubation rate of 100.0%. The ADR was comparable among the 3 groups, with no statistically significant difference ( P =0.702). VAS scores in the CAC group were significantly higher than those in the WAC and PWI groups (4.15±1.68 vs. 2.64±1.99 and 2.65±1.97; P <0.001, 95% CI: 1.049-1.968 and 95% CI: 1.035-1.949), whereas no statistically significant difference was found between the WAC and PWI groups ( P =0.949, 95% CI: −0.510 to 0.478). Compared with CAC (2.00 min) and WAC (2.55 min), the PWI group exhibited a shorter median insertion time (1.60 min, all P <0.001). The Hodges-Lehmann median differences were −0.80 minutes (95% CI: −1.00 to −0.50 min, PWI vs. CAC) and 1.20 minutes (95% CI: 1.00-1.50 min, WAC vs. PWI). Willingness to undergo repeat colonoscopy was comparable between WAC and PWI ( P =0.820), but significantly higher in these 2 groups than in the CAC group ( P =0.017). Conclusions: PWI appears to be associated with shorter insertion time among patients undergoing unsedated colonoscopy.
Background: The operational impact of transitioning from laparoscopic to robotic surgery is incompletely characterized, particularly regarding throughput and nonconsole operative time. Methods: We analyzed 1664 consecutive cases performed by a single surgeon (2023-2026), comparing laparoscopic (n=632) and robotic eras (n=1032). Throughput, operative time, and robotic OR overhead (skin-to-skin minus console time) were assessed using EMR, MBSAQIP, and vendor-derived data sources. Results: Weekly case volume increased from 9.54 to 11.36 (+19.1%), with stable OR days and increased cases per OR day (+17%). Robotic cases had longer operative times (SG +14.0 min; RYGB +27.6 min, P <0.001). The mean robotic OR overhead was ~19 minutes and consistent across independent data sources. Over time, overhead decreased by 30% (23.2 to 16.3 min; P <0.001), demonstrating improved efficiency. Conclusions: Transition to robotic surgery increased throughput despite longer operative times. Robotic OR overhead is substantial but declines with experience, suggesting recoverable efficiency gains over time.
