The first assistant plays an important role in the operating room in bariatric surgery. The aim of this study was to examine the relationship between the type of first assistants (FA) and operative time (OT) comparing robotic and laparoscopic approaches in bariatric surgery.


The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data for 2016-2019 was queried. Log-normal regression was performed to evaluate the impact of FA on OT variations within and between groups. The variations were then compared between different surgical approaches for each procedure type, while adjusting for patient characteristics, operation year, and the procedure variables.


A total of 666,182 patients who underwent robotic (R) and laparoscopic (L) sleeve gastrectomy, Roux-en-Y gastric-bypass, and duodenal switch, R-SG, L-SG, R-RYGB, L-RYGB, R-DS, L-DS, respectively, were included. The variability (percentage) was higher in the laparoscopic group (L-SG 8.05%, L-RYGB 9.19%, and L-DS 16.24%) compared to the robotic group (R-SG 1.91%, R-RYGB 5.04%, and R-DS 0.03%), Table 1. As the procedures become more complex (from SG to RYGB to DS), the impact of FA on OT variability in the laparoscopic approach increased. Conversely, the variability decreased in the robotic surgery group.


The FA has more of an impact on OT in the laparoscopic approach compared to the robotic approach. Our findings suggest that utilizing a robotic platform may reduce the need for skilled first assistants in complex bariatric surgery.