Testing the "use it or lose it" hypothesis: laparoscopic performance after robotic adoption in bariatric surgery.

Authors

Jayson Marwaha, Akram Irshaid, Matthew Bucala, Amanda Stricklen, Oliver A Varban, Jonathan F Finks, Nabeel Obeid, Michael Kia, Rachel Ross, Erin Charbeneau, Hope T Jackson, Amir A Ghaferi, Arthur M Carlin

Published in

Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. Oct 14, 2026. Epub Oct 14, 2026.

Abstract

Rapid adoption of robotic surgery has raised concerns about laparoscopic skill degradation through disuse and patient safety.
To determine whether bariatric surgeons who transition to predominantly robotic practice experience deterioration in laparoscopic operative performance.
Michigan Bariatric Surgery Collaborative, a statewide registry of 41 sites, United States.
This was a retrospective cohort study using a within-surgeon difference-in-differences design. The cohort comprised 127,004 primary laparoscopic and robotic sleeve gastrectomy or Roux-en-Y gastric bypass procedures from 2007 to 2025. Fifty-two surgeons crossed the 50% robotic adoption threshold, with adoptions concentrated between 2020 and 2025. Forty-eight surgeons had sufficient laparoscopic cases within analysis windows for inclusion in the primary analysis. The primary outcome was laparoscopic operative time; secondary outcomes were 30-day conversion, reoperation, leak, hemorrhage, emergency department visits, and readmissions.
The postadoption laparoscopic volume was reduced (median, 5 cases over 24 months; interquartile range, 1-27); 28 surgeons (58%) performed fewer than 10. Patient characteristics were balanced (maximum standardized difference, .07). Laparoscopic operative time did not meaningfully change postadoption (adjusted difference, +.23 min; 95% confidence interval [CI], -4.63 to 5.09; P = .93); the upper bound of the CI marginally exceeded the prespecified 5-minute threshold. Results were consistent across sensitivity analyses and procedure types, and clinical outcomes were stable. Robotic operative times decreased (-18.53 min; 95% CI, -25.07 to -11.98; P < .001), validating sensitivity to detect performance changes.
Bariatric surgeons maintained laparoscopic performance despite near-complete transition to robotic practice, suggesting that established surgical skills may resist decay from reduced practice frequency.

PMID:
43034137
Bibliographic data and abstract were imported from PubMed on 15 Nov 2026.

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