Perioperative Outcomes of Robot-Assisted Versus Laparoscopic Sleeve Gastrectomy

Rena C Moon, MD, Derek Stephenson, MD, Andre F Teixeira, MD, Muhammad A Jawad, MD, FACS. Orlando Regional Medical Center.

Background: Currently, sleeve gastrectomy(SG) is most commonly performed laparoscopically. However, robot-assisted approach for sleeve gastrectomy is increasing in number among bariatric surgeons. The aim of our study is to compare perioperative outcomes of laparoscopic SG and robot-assisted SG.

Material and Methods: Between May 2012 and June 2013, 50 patients underwent laparoscopic SG and 90 underwent robot-assisted SG at our institution. The first 40 robot-assisted cases were excluded from current study to minimize the influence of learning curve. A retrospective review of a prospectively collected database was performed for 50 laparoscopic and 50 robot-assisted SG patients, noting the outcomes and complications of the procedure. Perioperative outcomes were length of operation, intraoperative blood loss, length of stay, and mortality and complication within the first 30 days.

Results: Laparoscopic group had lower mean preoperative body mass index(BMI) of 43.9±5.9kg/m2 (range 34.2-60.7) when compared with the that of robot-assisted group 47.9±9.0kg/m2 (range 34.4-67.4)(p<0.02). All the other demographics were clinically comparable in these two groups. Mean length of operation was 91.1±21.1 minutes(range 59-148) in the laparoscopic group, and 120.6±25.9 minutes(range 75-200) in the robot-assisted group(p<0.001). Mean intraoperative blood loss was 21.0±17.3ml (range 5-100) in the laparoscopic group, and 36.3±28.3ml (range 10-150) in the robot-assisted group(p<0.002). Mean length of stay was 1.1±0.3days(range 1-2) in the laparoscopic group, and 1.3±0.5days(range 1-3) in the robot-assisted group(p<0.05). Three (6.0%) patients in the robot-assisted group were found to have leak within the first 30 days, and required readmissions. No patient in the laparoscopic group developed leak, two patients required readmission due to abdominal pain and chest pain and both were managed conservatively. No mortality occurred within the first 30 days.

Conclusions: Robot-assisted SG may result in longer operation, more intraoperative blood loss, longer length of hospital stay, and higher complication rate.