Netanel Alper, MD, Brian Bassiri-Tehrani, MD, Yael Marks, MD, James Taggart, MD, Julio Teixeira, MD. Lenox Hill Hospital
Introduction: Robotic-assisted bariatric surgery has been shown to be safe in several studies1,2,3. One recent advance in robotic instrumentation is the development of the robotic stapler. Whereas previously, robotic-assisted bariatric procedures required stapling via a laparoscopic assistant port, the robot now has the capability to integrate robotic stapling into the procedure. To date, there has been no study evaluating the safety of robotic stapling. This study aims to determine the safety and efficacy of the robotic stapler in bariatric operations.
Methods: This study looks at the experience of a single surgeon in a single institution from 2015-2016. A prospectively collected, retrospectively analyzed database of all robotic-assisted bariatric operations was analyzed. Demographics, robotic stapler usage and misfire rate were evaluated for the primary surgery group and the revision surgery group. Fisher’s exact test was used to determine statistical significance between the two groups.
Results: A total of 97 robotic bariatric operations were performed during the study period. Forty of these made use of the robotic stapler, and 57 used laparoscopic stapling via assistant port. In the robotic stapling group, the operations included: 21 Vertical Sleeve Gastrectomies, 10 revisions of prior bariatric operations, 8 Roux-en-Y Gastric Bypasses, 1 Modified Duodenal Switch. This group comprised 5 males and 35 females, with a mean age of 44.2 and a mean BMI of 44.4. In this group, two out of ten (20.00%) revision cases experienced misfire, and none of the primary cases misfired (p= 0.057). Both of these patients subsequently developed staple line leak complications, whereas none of the other patients that underwent robotic stapling did. Out of a total of 278 total robotic staple loads fired, two misfired, giving a total misfire rate of 0.72%. Two hundred eighteen robotic staple loads were fired in primary operations with no misfires (0.00%) and 60 were fired in the revision group with two misfires, giving a misfire rate of 3.33% (p=0.046).
Conclusion: This study demonstrates the safety of robotic staplers in primary bariatric surgery. However, in the revision group there were two misfired staple loads suggesting that the safety may not be as well established in this population. Possible explanations could be surgeon technique, differences in tissue quality in revision surgery, and instrument malfunction. Further investigation is needed to fully establish the safety of the robotic stapler in revision bariatric surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80307
Program Number: P677
Presentation Session: Poster (Non CME)
Presentation Type: Poster