Opioid Consumption and Postoperative Pain in Robotic Versus Laparoscopic Bariatric Surgery: A Meta-Analysis and Systematic Review

Abstract

Introduction:

Obesity is a major global health issue, for which bariatric surgery, particularly sleeve gastrectomy (SG), has emerged as the most effective intervention. In recent years, the surgical approach to SG has evolved from open and laparoscopic techniques to robotic-assisted surgery. However, postoperative pain remains a significant concern, driving the need for opioid-sparing strategies. While some studies suggest that the robotic approach may reduce postoperative pain and opioid consumption, others report no significant difference compared with conventional laparoscopy. This systematic review and meta-analysis aim to evaluate the impact of robotic-assisted bariatric surgery on postoperative opioid use and pain control compared with the laparoscopic approach.

Methods:

A comprehensive online search was conducted across databases (PubMed/MEDLINE, EMBASE, ClinicalTrials.gov, and Cochrane Library) from inception to December 2024. Observational studies and clinical trials exclusively comparing inpatient opioids use between patients undergoing primary laparoscopic and robotic bariatric surgeries RBSs), with no restrictions on language. The primary outcomes were postoperative pain scores, total inpatient opioid use in morphine milligram milliequivalent (MMEs), and number of patients that received opioid at discharge. Secondary outcomes included length of stay and readmission rates. Meta-analysis was performed using Review Manager (RevMan) version 5.4, and heterogeneity was assessed using I² statistics.

Results:

A total of 53 studies were screened, of which 11 were fully reviewed, and 6 observational studies involving 2334 patients were included in the analysis. Preoperative BMI ranged from 43.3 ± 5.3 to 49.9 ± 9.3 in the RBS group and from 45.0 ± 7.4 to 49.7 ± 8.8 in the laparoscopic bariatric surgery (LBS) group. Pain scores, assessed using the Numerical Rating Scale, 10-point Likert scales, and Visual Analog Scale, ranged on postoperative day one from 0.7 ± 1.4 to 4.4 ± 1.8 in the RBS group and from 1.6 ± 2.3 to 4.5 ± 1.7 in the LBS group; on postoperative day 3, values ranged from 3.3 ± 1.7 to 5.0 ± 5.0 in RBS and from 1.26 ± 2.3 to 3.7 ± 1.9 in LBS. Postoperative opioid use ranged from 10.3 ± 1.2 to 2889.4 MME in RBS and from 16.3 ± 21.9 to 2890 MME in LBS. The proportion of patients discharged with opioids varied from 42.3% to 91.8% in RBS and from 50.2% to 89.2% in LBS. Thirty-day readmission rates ranged from 2.4% to 13.5% in RBS and from 6.3% to 7.3% in LBS. Meta-analyses showed that RBS was associated with lower postoperative pain on Day 1 (standardized mean differences: –0.22; 95% CI: –0.41 to –0.04; P = .02; I² = 54%) and reduced opioid consumption (mean differences: –7.65; 95% CI: –9.05 to –6.25; P < .004; I² = 78%). Furthermore, the RBS group demonstrated lower odds of opioid prescription at discharge; however, this difference did not reach statistical significance (odds ratios: 0.74; 95% confidence interval: 0.55 to 1.00; P = .05; I² = 28%).

Conclusion:

RBS is associated with lower postoperative pain on day 1 and reduced opioid consumption compared with LBS. Although fewer opioid prescriptions at discharge were observed in the robotic group, this difference was not statistically significant.