Robotic Vs. Conventional Laparoscopic Gastric Banding: A Comparison of 407 Cases

INTRODUCTION: The current indications and rationale for using a robotic technique in bariatric surgery, specifically gastric banding, remain unclear. The objective of this study was to quantify the safety and potential benefits of this novel technology in the context of both patient and surgeon outcomes as compared to the conventional laparoscopic approach.

METHODS AND PROCEDURES: A retrospective database of obese patients undergoing laparoscopic gastric banding (LGB) between December 2006 and June 2009 was examined. During this period 407 consecutive patients underwent LGB: 287 robotically and 120 conventionally. The procedures were performed by two primary surgeons in a teaching hospital setting. The conventional laparoscopic approach had been practiced since 2004, and the robotic approach had been practiced since 2006. Patient demographics, operative complications, operating times, and clinical outcomes were examined.

RESULTS: The patients in the robotic and conventional cohorts did not vary significantly in demographic composition. The robotic cohort had a mean age of 47 ± 25 years, was 230/287 (80.1%) female and 57/287 (19.9%) male and had a mean pre-operative Body Mass Index (BMI) of 45.4 kg/m². The conventional cohort had a mean age of 45 ± 24 years, was 89/120 (74.2%) female and 31/120 (25.8%) male, and had a mean pre-operative BMI of 45.1 kg/m². The prevalence of pre-operative co-morbidities was similar between the two groups: hypertension was 56% and 67%, hypercholesterolemia was 29% and 33%, sleep apnea was 54% and 52%, diabetes mellitus was 28% and 33%, and osteoarthritis was 41% and 29% in the robotic and conventional cohorts respectively. The rates of intra-operative and post-operative complications did not differ significantly between the two approaches (Table 1). The length of post-operative hospital stay did not differ significantly between the two approaches (1.3 ± 2.7 days for both approaches). The operating time from incision to wound closure did not differ significantly between the two approaches (91.5 minutes vs. 92.1 minutes robotic and conventional respectively). However, for patients with a pre-operative BMI of ≥ 50 kg/m² (N = 89: 64 robotic, 25 conventional), the operating time is significantly lower using the robotic approach (91.3 ± 63.7 minutes, SD = 19.7 vs. 101.3 ± 49.7 minutes, SD = 23.7; p=0.04).

CONCLUSIONS: In this series, robotic and conventional approaches were similar in intra-operative or post-operative complication rates, operating time, and length of post-op hospital stay. However, for patients with a pre-operative BMI of ≥ 50 kg/m², the operating time is significantly lower using the robotic approach despite the adoption of the new technique. These data suggest that the robotic approach is at least as safe as conventional laparoscopic approach, and that robotic approach should be considered for gastric banding candidates with BMI ≥ 50 kg/m².

Table 1: Complications of robotic vs. conventional approaches

Complication Robot (N=287) Conventional (N=119)
Conversion to open 0 1
Reoperation: Band removal or replacement 9 3
Port removal or replacement 2 2
Band slippage 8 3
GIcomplaints not resulting in admission 28 10

Session: Podium Presentation

Program Number: S054

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