A Comparative Study of Robotic Sleeve Gastrectomy and Robotic Gastric Bypass: A Single Institution Experience.

Anthony M Gonzalez, MD, FACS, FASMBS, Jorge R Rabaza, MD, FACS, FASMBS, Rupa Seetharamaiah, MD, FACS, Charan Donkor, MD, Rey Romero, MD, Radomir Kosonovic, MD, Jonathan Arad, MD

Baptist Health South Florida, Florida International University Herbert Wertheim College of Medicine

INTRODUCTION: Obesity has evolved into a worldwide epidemic affecting people of all ages, races and creeds. To date, Minimally Invasive Surgery (MIS) has shown optimal results for weight loss in bariatric patients dealing with morbid obesity. Furthermore, impressive results have been seen with the introduction of the daVinci robotic to bariatric surgery due to its multiple advantages i.e. 3-D visualization, instrument articulation and improved surgeon ergonomics. Accordingly, yet to be determined, is which minimally invasive robotic surgery is the best procedure for weight loss in patients with morbid obesity. The purpose of this study is to compare our preliminary experiences of Robotic Sleeve Gastrectomy (RSG) and Robotic Gastric Bypass (RGB).

METHODS: We retrospectively collected, under IRB approval, RSG & RGB data (from 09/2009-06/2012 & 08/2009-05/2012, respectively) that was performed by two surgeons at a single surgery center. All of the robotic procedures were performed using the daVinci® Surgical System. Follow up was achieved at 1-3, 4-6, 7-9 and >12months after surgery. Information was collected focusing on surgical time, hospital length of stay, preoperative BMI, complications (i.e. leakage, strictures, bleeding, obstruction and/or ulcer formation) and Excess of Weight loss Percentage (EWL%).

RESULTS: This study included 134 RSG and 165 RGB patients. The mean age was 43 (±12.6) and 44.7 (±13.3) years old (P= 0.28), and the mean initial BMI was 45 (±7) and 47.4 (±9.8) kg/m2 (P< 0.02), in RSG and RGB respectively. Mean surgical time in the RSG cohort was 106.6 and 140.7 min in the RGB cohort (P< 0.01), as well as a similar mean hospital length of stay of 2.2 days in both groups. Perioperative complications, which occurred in the RSG were: 1 (0.7%) sleeve torsion and 2 (1.4%) thrombotic events, while those seen in the RGB were: 1 (0.6%) stricture, 3 (1.8%) bleeding events and 3 (1.8%) cases of an ulcer formation, in addition there were no leaks noted in either cohort. Postoperative follow up in both groups (RSG and RGB) was conducted at 1-3, 4-6, 7-9 and >12 months showing an EWL% of 23.3% and 25.1%, 46.2% and 46.5%, 55% and 57.6%, and 71.5% and 68.9% respectively.

CONCLUSIONS: Our results show that both RSG and RGB are safe and effective procedures for the treatment of morbid obesity showing comparable weight loss results, low rates of bleeding, strictures and no evidence of leaking from the anastomotic sites. At one-year follow up, EBL% are similar in both operations. Additional studies with larger numbers, longer follow-up and evaluation of patient satisfaction are still needed.

Session: Podium Presentation

Program Number: S034