Robotic Vertical Sleeve Gastrectomy: Outcomes and Cost-Analysis of 411 cases

Brett L Ecker, MD1, Richard Maduka, BS2, Andre Ramdon, MD1, Daniel T Dempsey, MD1, Kristoffel R Dumon1, Noel N Williams1. 1University of Pennsylvania, 2Perelman School of Medicine at University of Pennsylvania

Introduction: Robotic technology is increasingly prevalent in bariatric surgery yet there are few published cohort analyses of the robotic sleeve gastrectomy to date. We sought to evaluate the experience of a single high-volume bariatric practice in a teaching hospital in order to accurately characterize the procedure’s outcomes, potential benefits, and its feasibility as a teaching model for surgical residents.

Methods and Procedures: Following IRB approval, all patients who underwent robotic sleeve gastrectomy at our institution between September 1, 2011 and April 30, 2014 were identified from a prospectively maintained administrative database. Hospital records were evaluated for patient demographics, operative time, robot usage time, estimated blood loss, operative complications, postoperative morbidity and mortality, and direct and supply costs of the procedure. Analysis of data was performed using SPSS 22.0 statistical analysis software (SPSS Inc., Chicago, IL, USA).

Results: A total of 411 patients successfully underwent robotic sleeve gastrectomy. Mean operative time was 75.1 ± 23.9 minutes (range 32.0 – 175.5 min) with an associated mean robot usage time of 63.9 minutes (range 30.0 –122.0 min). Mean estimated blood loss was 47.8 mL and no patients (0%) required an intra-operative blood transfusion. 90-day morbidities included reoperation (0.72%), bleeding complications (0.48%), leak (0.24%), stricture (0.97%), need for blood transfusion (3.86%), surgical site infection (1.69%), DVT (0.48%), and PE (0.48%). Mortality was 0.00%. Introduction of the new technologic platform required approximately twenty cases prior to institutional proficiency. Resident proficiency in the robotic platform as measured by mean operative time of the resident cohort was achieved after five cases. Subset analysis for fiscal year 2014 demonstrated an increase in supply cost with the robotic interface (p=0.01) but no difference in mean direct cost for laparoscopic sleeve gastrectomy versus robotic sleeve gastrectomy.

Conclusions: Robotic sleeve gastrectomy is a safe procedure with minimal morbidity that can be instituted without increased direct cost as compared to its laparoscopic equivalent. The robotic platform is a valuable component of resident education.

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