ORIGINAL CONTRIBUTIONS Technique Evolution, Learning Curve, and Outcomes of 200 Robot-Assisted Gastric Bypass Procedures: a 5-Year Experience Vivek Bindal & Raquel Gonzalez-Heredia & Mario Masrur & Enrique F. Elli # Springer Science+Business Media New York 2014 Abstract Background We evaluate our 5-year experience, evolution of technique, and clinical outcomes with robot-assisted RYGB. Methods Two hundred consecutive patients who underwent robot-assisted RYGB at our center were included. Among them, 118 patients underwent a hybrid robot-assisted laparoscopic RYGB (LRRYGB), and 82 patients underwent a totally robotic RYGB (TRRYGB). Patient demographics, clinical characteris- tics, comorbidities, operative parameters, conversions, morbidi- ty, mortality, and excess weight loss were analyzed. Results Most of the patients (88 %) were female with a mean age of 41.9 years and mean BMI of 46.6 kg/m 2 . The outcomes of patients who underwent LRRYGB (n =118) were compared to those who underwent TRRYGB (n =82). The mean opera- tive time in TRRYGB group was 170.9±51.4 min which was significantly lower than LRRYGB group (216±54.1 min). The mean operative time for the last 100 patients was significantly lower than that for the first 100 patients. The excess weight loss (EWL) was 58.3 % at 6 months, 67.7 % at 1 year, 71.6 % at 2 years, and 65 % at 3 years. There were three conversions to open, three reoperations and four readmissions. There were no anastomotic leak, major bleed, gastrojejunostomy stricture, or mortality seen in our series. Conclusions Use of robot assistance to perform RYGB is safe and may reduce the associated complications, namely, anas- tomotic leak, gastrojejunostomy (GJ) stricture, and hemor- rhage. Excess weight loss at 2 years after RRYGB is compa- rable to laparoscopic RYGB. Keywords Robotic bariatric surgery . Robotic gastric bypass . Robotic surgery outcomes . Robotic surgery learning curve . Robotic surgery . Roux-en-y gastric bypass Introduction Use of Robotics in Bariatric surgery has been evolving since Cadiere et al. reported the first such case in 1999 [1]. Bariatric surgery can be challenging in many situations because of large patients, large livers, thick abdominal walls with torque on rigid instruments, and substantial visceral fat making expo- sure, dissection, and reconstruction difficult [2]. Robotic sur- gery has provided the surgeons with the advantage of three- dimensional vision, increased dexterity, and precision by downscaling surgeon’ s movements enabling a fine tissue dis- section [3, 4]. It overcomes the restraint of torque on ports from thick abdominal wall and minimizes port site trauma by remote center technology [5]. The main limitation with robotic surgery is the perceived higher cost and setup time compared to laparoscopy. But with increased experience, it is seen that setup times reduce and costs may also come down as material prices reduce [6]. Roux-en-Y Gastric Bypass (RYGB) is considered as the gold standard surgical procedure for morbid obesity by many specialists [7, 8]. The overall results are good in terms of both weight loss and comorbidity resolution [9]. Robotic surgery is currently considered as an attractive technology that could help to perform RYGB [ 10]. We evaluate our 5-year V. Bindal (*) : R. Gonzalez-Heredia : M. Masrur : E. F. Elli Division of General, Minimally Invasive & Robotic Surgery, University of Illinois at Chicago, 840 S Wood St, Suite 435E, M/C 958, Chicago, IL 60612, USA e-mail: bindal.vivek@gmail.com R. Gonzalez-Heredia e-mail: rgheredi@uic.edu M. Masrur e-mail: mariomasrur@hotmail.com E. F. Elli e-mail: eelli@uic.edu OBES SURG DOI 10.1007/s11695-014-1502-9