What 2,500 Robotic Surgery Cases Have Taught Dr. Hesham Atwa
About Choosing the Right Surgical Approach
Patients often arrive at a consultation wondering: ‘Should I have robotic surgery?’ It is a fair question, but it is rarely the first one that needs answering. After more than 2,500 robotic surgeries and over 13,000 procedures in total, Dr. Hesham Atwa of Long Island Laparoscopic Doctors has learned that the right surgical approach starts with the patient, not the technology.
Dr. Atwa has practiced through three eras of surgery: open operations, then laparoscopic surgery, and now robotic surgery. He was fellowship trained in advanced laparoscopic surgery, began practice on Long Island in 2001, and is now a designated Master Surgeon in Robotic Surgery. That long view shapes how he matches each patient to an approach.
Here are six lessons from those cases.
Lesson 1: Start with the patient, not the platform
The first decision is which treatment fits your health, your goals, and your life. For weight loss, that might be gastric sleeve, gastric bypass, a revision of an earlier operation, or a non-surgical program. Only after that decision does the question of robotic versus laparoscopic come up.
This is also what leading medical institutions advise. Mayo Clinic notes that robotic surgery is not an option for everyone and encourages patients to ask how it compares with other minimally invasive techniques and with open surgery.1
Lesson 2: The robot earns its place in complex cases
Robotic instruments bend and rotate like a wrist, and the surgeon sees a magnified 3D view.1 Those advantages matter most when the operation is technically demanding such as working through scar tissue, sewing new connections deep in the abdomen, or repairing a complex hernia.
National data support this. A study of more than 41,000 revisional bariatric operations in U.S. accredited centers found that revisional gastric bypass performed robotically had a lower overall complication rate than the laparoscopic approach (4.8 percent versus 6.2 percent) and a slightly shorter hospital stay.2 It is one reason the share of revisional gastric bypass cases done robotically rose from 7.3 percent in 2015 to 32 percent in 2022.2
For patients who need revisional bariatric surgery, such as converting a sleeve to a bypass or revising a gastric band, this is where an experienced robotic surgeon can make a meaningful difference.
Lesson 3: For simpler operations, either approach can be excellent
The same national study found that for revisional sleeve gastrectomy, results were similar whether the surgery was robotic or laparoscopic.2 The honest takeaway is that robotic surgery is not automatically better for every procedure. Both approaches are minimally invasive, with small incisions and a faster recovery than open surgery.
A surgeon who is skilled in both can recommend what suits you, instead of fitting every patient to a single tool.
Lesson 4: Efficiency is a patient safety issue
Nationally, robotic operations take longer than laparoscopic ones. In the revisional study, robotic gastric bypass averaged about 166 minutes compared with about 131 minutes laparoscopically.2 The authors noted that this gap may narrow as surgeons gain experience.
This is a theme Dr. Atwa cares about deeply. His best-selling book, Mastering Robotic Surgery: Ordinary Surgeons Doing Extraordinary Things, was written to help other surgeons become more efficient and reduce complications. A well-rehearsed surgeon and operating room team can mean less time under anesthesia for the patient.
Lesson 5: Experience and volume matter as much as the approach
A 2025 review of 36 studies found that higher surgeon and hospital volumes in bariatric surgery were associated with lower short-term mortality, fewer complications, and shorter hospital stays.3 The approach matters. Who performs it, and how often, matters too.
Dr. Hesham Atwa is a proctor for Intuitive, the maker of the da Vinci system, and trains other surgeons in robotic technique. He serves as Director of Robotic Surgery at St. Charles Hospital, where visiting surgeons come to observe his cases.
Lesson 6: Surgery is one part of the plan
The best-chosen operation still depends on what happens before and after it. At Long Island Laparoscopic Doctors, patients have access to nutritional counseling, support programs, and long-term follow-up. For some patients, the right first step is not surgery at all, but a medical weight loss program.
How the right approach is chosen for you
At your consultation, expect a conversation about:
- Your health history, including any previous abdominal or bariatric surgery
- Your goals, such as weight loss, diabetes improvement, reflux relief, or hernia repair
- The procedure that best fits those goals
- Whether a robotic or laparoscopic approach is the better match, and why
- What recovery and follow-up will look like
Find the right surgical approach on Long Island
There is no single best operation and no single best technique. There is the right approach for you, chosen by a surgeon with the experience to offer every option. To talk with Dr. Atwa and the team at Long Island Laparoscopic Doctors, call (631) 476-9296, request a consultation, or register for a free webinar.
References
1 Mayo Clinic Staff. Robotic surgery. Mayo Clinic. Updated April 13, 2024. mayoclinic.org
2 Spurzem GJ, Broderick RC, Kunkel EK, et al. Robotic bariatric surgery reduces morbidity for revisional gastric bypass when compared to laparoscopic: outcome of 8-year MBSAQIP analysis of over 40,000 cases. Surg Endosc. 2024;38:6294-6304. doi:10.1007/s00464-024-11192-0
3 Campione A, Nimptsch U, Eckhardt H, et al. Volume-outcome relationships in bariatric surgery: a rapid review. Int J Obes. 2026;50:33-52. doi:10.1038/s41366-025-01931-1