Robotic Versus Laparoscopic Sleeve Gastrectomy for Morbid Obesity: A Meta-analysis

Kandace Kichler, MD1, Jessica L Buicko, MD1, Lucy M De La Cruz, MD1, Leonardo Tamariz, MD, MPH2, Srinivas Kaza, MD, FACS1. 1University of Miami Palm Beach Regional Campus, 2University of Miami

Introduction: Sleeve gastrectomy (SG) represents the fastest growing bariatric surgical procedure currently performed worldwide for morbid obesity. As compared to other bariatric surgical procedures, SG is considered relatively simple, safe, and associated with few long term complications. In addition, SG provides the opportunity to act as a bridge for future procedures in the super obese, improving comorbidities before laparoscopic Roux-en-Y gastric bypass (RYGB). Several variations in technique have been described, but the most popular technique to date is the laparoscopic approach. With the technological advancement in minimally invasive surgery via development of the da Vinci surgical system (Intuitive, Sunnyvale, CA), many surgeons have adopted the robotic technique in other bariatric surgical procedures, including the RYGB and adjustable gastric banding. Advantages of the robotic platform include increased visualization, especially at the esophageal hiatus, maneuverability, and better triangulation of instruments. The purpose of this meta-analysis was to compare the clinical safety and efficacy of robotic sleeve gastrectomy (RSG) with laparoscopic sleeve gastrectomy (LSG).

Methods and Procedures: A MEDLINE database search was performed with secondary referencing to identify studies suitable for inclusion. Selected studies included those in which RSG and LSG were compared in terms of perioperative outcomes. A two researcher manual analysis of selected papers was carried out. Evaluated variables included operative time, perioperative bleeding, length of stay, stricture formation, leak rate, and mean BMI after one year. We calculated the I squared statistic as a measure of heterogeneity. We used two different pooled statistics. Relative risk (RR) was determined for categorical outcomes, and standardized mean difference (SMD) was calculated for continuous outcomes.

Results: Four studies matched the selection criteria and reported on a total of 3599 sleeve gastrectomy cases. Of these, 280 cases were RSG and 3319 were LSG. Comparing RSG to LSG, we found favorable outcomes in regards to mean BMI after one year (SMD: -0.243; 95% CI: -0.466- -0.019; p = 0.033). However, operative time was increased (SMD: 0.602; 95% CI: 0.417-0.788; p < 0.01). Other results were not significant, including leak rate (RR: 0.433; 95% CI: 0.115-1.638; p = 0.218); perioperative bleeding (RR: 0.578; 95% CI: 0.161-2.075; p = 0.401); stricture formation (RR: 1.809; 95% CI: 0.249-13.132; p = 0.558); and length of stay (SMD: -0.078; 95% CI: -0.260-0.105; p = 0.404).

Conclusions: Robotic sleeve gastrectomy for morbid obesity as compared to LSG shows a significantly increased operative time. In regards to mean BMI at one year, RSG is superior to LSG. There was no significant difference in terms of LOS, perioperative bleeding, leak rate, or stricture formation. RSG is a safe and feasible alternative to conventional LSG. Further comparative studies may shed additional light on perioperative outcomes.

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