Is the Robotic Sleeve Gastrectomy Comparable to Laparoscopy: A Single-Institution Retrospective Review of 376 Cases

Vladimir Davidyuk, MD, Tejinder P Singh, MD, Brian R Binetti, MD, Daniel J Bonville, DO, Erin Corsini. Albany Medical Center

Background: Sleeve gastrectomy has in the past comprised the first part of the duodenal switch procedure, but now is an established bariatric surgical procedure and has gained in popularity in recent years due to its safety and efficacy.  With the increasing accessibility of robotic technology, outcomes comparing laparoscopic sleeve gastrectomy (LSG) with robotic-assisted sleeve gastrectomy (RSG) are not widely reported or are equivocal in nature.  This investigation aims to determine outcomes of LSG as compared to RSG.

Materials and Methods: This study is a nonrandomized, controlled, retrospective review of 376 patients who underwent elective minimally invasive sleeve gastrectomy at the Albany Medical Center Hospital from July 2008 to March 2014.  A total of 246 patients underwent laparoscopic sleeve gastrectomy, while 130 underwent robotic sleeve gastrectomy using the da Vinci Surgical System®.  Patient demographics, comorbidities, as well as any concurrent procedures were recorded.  Results that were collected and analyzed include: operative time, length of hospital stay, estimated blood loss, mean length of follow-up, excess body weight loss at 1 year and postoperative complications.  Data were analyzed using Stata software with the help of a statistician.  Χ2 test was used for categorical variables and t-test was used to continuous variables.  P≤0.05 was considered statistically significant.

Results:

  Laparoscopic Robotic P value
Excess Weight loss at 1 yr(%) 61.7 62.8 0.75
Hospital length of stay(days) 3.04 2.87 0.48
Estimated blood loss (ml) 54.5 33.7 0.0010
Operative time(minutes) 113 110 0.55
Total complications n(%) 21(8.5%) 8(6.2%) 0.41

Demographic data between the two groups were similar.  The mean length of stay, operative time and excess weight loss at 1 year were similar between both groups. The estimated blood loss was statistically significant, however the difference is not clinically significant.  The percentage of patients with intraoperative and postoperative complications  for each type of procedure is similar.  In this study operative time was recorded from time-out until skin closure.  In our study, unlike in previous reports the operative time was the same for both types of cases.

Conclusion: The operative time and complications are similar between both groups.  Robotic sleeve gastrectomy has comparable outcomes to laparoscopic sleeve gastrectomy with potential for future improvements as technology continues to advance.

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