J. P. Kuckelman1, T. Holtestaul1, D. Lammers1, J. Bingham1 1Madigan Army Medical Center,General Surgery,Tacoma, WA, USA
Introduction: The increasing comfort with robotic methods in concert with technological advances has led to a surge in robotic approaches for bariatric operations, the most common of which being sleeve gastrectomy (SG). The progression of robotic use for bariatric procedures has forged forward despite a lack of evidence-based support. Current database studies have demonstrated conflicting data regarding the safety of the robotic approach for sleeve gastrectomy. We evaluate the safety and effectiveness of robotic methods when compared to a standard laparoscopic approach.
Methods: Retrospective review of all SG performed between 2010 and 2017 at a single bariatric center of excellence. Patients were followed for a minimum of 3 months with ongoing follow up to one year. Cases were grouped as laparoscopic (LSG) or robotic (RSG) and propensity matched for age, sex, BMI, and co-morbidities. Patient characteristics, intra-operative indices as well as follow up data including weight loss was collected. Patients were categorized based on operative approach and propensity matched for comparison.
Results: 479 patients were included with the majority being categorized as laparoscopic sleeve gastrectomy (LSG, N=403) with 76 patients included in the robotic group (RSG). There was 99% follow up for 30 day outcomes. LSG had significantly more patients with pre-operative diabetes at 15.8% compared to 1.3% in the RSG group (p=0.003). There were no differences in terms of pre-operative age, weight, BMI, smoking status, ASA, or rates of any other comorbidity. Operative time was significantly longer with RSG at 138 minutes compared to 104 minutes with LSG (p=<0.001). There were no differences in rates of intra and post-operative blood transfusions, hospital length of stay, unplanned return to the operating room or readmission (Figure). Propensity matching resulted in reduction to 75 patients in each group and did not alter the primary results. Estimated percent weight loss (EWL%) was similar at 3 and 6 months between the two groups. Only 41 patients met had 12-month follow-up in the RSG group but EWL% was significantly lower with RSG at 101% compared to 60% in the LSG group (p=<0.001, see figure).
Conclusion:Robotic sleeve gastrectomy was found to be safe and effective with similar results in terms of weight loss when compared to laparoscopic sleeve gastrectomy. Operative times were longer with a robotic approach which did not result in any adverse postoperative events.
