Robot-assisted vs Laparoscopic Assisted Sleeve Gastrectomy: Comparison of 108 Cases.

Umashankkar Kannan1, Rashikh Choudhury2, Daniel T Dempsey3, Noel N Williams3, Kristoffel R Dumon3. 1Bronx Lebanon Hospital Center, Bronx, NY, 2Johns Hopkins Hospital, Baltimore, Maryland, 3Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

Background: The purpose of this retrospective study is to report our early experience with Robotic-Assisted Laparoscopic Sleeve gastrectomy (RALSG) in comparison to laparoscopic assisted sleeve gastrectomy (LASG) in the setting of a university teaching hospital.

Methods: The study included 108 patients who underwent sleeve gastrectomy either via the Laparoscopic-assisted or robotic-assisted approach from February 2010 to February 2012. Of these 108 patients, 62 underwent LASG and 46 underwent RALSG. Patient demographics, operative complications, total operative times, and clinical outcomes were measured and analyzed. Comparison between the laparoscopic and robotic groups was performed using Fisher's exact test for discrete variables and Mann-Whitney's test for continuous variables.

Results: The patients in the robotic and laparoscopic groups did not have a statistical difference in their demographics or baseline preoperative comorbidities. The mean operating time did not differ significantly between the two groups (123 minutes versus 115 minutes). Additionally, there was no significant learning curve, in terms of time to complete operation after the RALSG procedure was started. There was no mortality in either group. There was also no anastomotic leak or bleeding complications in both the groups. Laparoscopic group had two surgical site infections while there was no infection in the robotic group. The length of postoperative hospital stay was slightly lower for the robotic group compared to the laparoscopic group (4.6 vs 4.23 days, p= 0.007). There were 3 (5%) readmissions in the laparoscopic group and 7 (15%) in the robotic group. The mean estimated excess weight loss in percent (EWL%) at 3 months, 6 months and 1 year was greater in the robotic group (26.66 versus 21.72 at 3 months, p=0.05 and 39 versus 34 at 6 months, p=0.025, 57.39 versus 47.65 at 1year, p=0.087). The difference in weight loss was statistically significant at 3 and 6 months while not significant at 1 year follow up. Average costs for robotic supplies was 11% (p < 0.001) higher than laparoscopic supplies while the total hospitalization cost was 7% higher (P< 0.001) for the robotic group.

Conclusions: Early results of our experience with RALSG show low perioperative complication rates and satisfactory results with weight loss in the short term which are comparable with LASG with no statistically significant difference between intra-operative and postoperative complications between the two surgical groups.

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