Robotic bariatric surgery: the Italian point of view to go beyond

Italian robotic community discussed critical issues about data of robotic bariatric surgery activity in Italy. A working group of Italian bariatric surgeon evaluated the current evidence on robotic use discussed its limits, advantages and future perspective in bariatric field. The chair of the working group (MR) and a group of participants (G.F., B.P., G.N.) reported results of Italian SICOB Registry data and discussed about future perspective on the behalf of the Italian Working Group on Robotic Bariatric Surgery (IGRoBS). Material: Database of SICOB Italian Registry was analysed since 2014. All procedures were categorized by years from 2014 to October 2024 and evaluated compared than total bariatric procedures (robotic rate). Type of procedures was classified: Roux-en-Y gastric bypass (RYGB), One-anastomosis gastric bypass (OAGB), Sleeve Gastrectomy (SG), Single anastomosis duodenal-ileal bypass (SADIS), Gastric Plication (GP), Gastric Banding (GB). Results: 168.309 bariatric procedures from 2014 to October 2024 was recorded in SICOB Registry. 1086 procedures (0.64%) were recorded as robotic approach. Robotic bariatric procedures increased by years from 19 robotic procedures in 2014 to 344 procedures in the first 10 months in 2024. Robotic bariatric rate increased in the last years from 0,2% in 2014 to 3,7% in 2024. Robotic procedure types were RYGB 549, SG 433, OAGB 73, SADIS 21, GP 10, GB 5. In the last year, robotic SG was more widespread than other procedures (174 SG versus 147 RYGB). Conclusion: Data showed an increased robotic activity in Italy. Literature reported that more complex procedures, such as revisional procedures, bariatric procedures combined with hiatal hernia repair, and complex cases, including superobese patients and procedures requiring manual anastomosis are promising areas for validating the use of robotic surgery. Future prospective could be resume in three answer: could robotic platforms be more useful than laparoscopy for achieving a safe and efficient learning curve? Could it offer a viable path toward solo-surgery? Could it value for AI applications, and for training and proctoring of new users?