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Robotic Versus Laparoscopic Sleeve Gastrectomy Outcome Trends Over Time: Are We Improving?

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Abstract

Background

Sleeve gastrectomy (SG) is an effective treatment option for patients with obesity. Robotic sleeve gastrectomy (RSG) is reported to have worse short-term patient outcomes compared to laparoscopic SG (LSG), but prior studies may not have accounted for evolving technology, including stapler utilization.

Objective

This study compared RSG and LSG outcomes over different time periods.

Setting

Academic Hospital.

Material and Methods

The 2015 to 2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) databases were used. Matched cohort analyses compared adverse outcomes within 30 days for the 2015–2018 and 2019–2021 cohorts. Bivariate and regression models compared cohorts using Stata/MP 17.0.

Results

Seven hundred sixty-eight thousand and sixty-nine SG were analyzed. Over the 7-year study period, all patient outcomes, operation length (OL), and length of stay (LOS) trended downward for RSG, except surgical site infection (SSI). In the 2015–2018 cohort, leak was significantly higher with RSG (OR 1.53), and OL and LOS longer (p < 0.001). In the 2019–2021 cohort which corelated with a significant increase in robotic cases, leak (OR 1.36), SSI (OR 1.46), and morbidity (OR 1.11) were higher with RSG. While the mean difference in OL and LOS decreased between the two time periods, they remain longer for RSG (p < 0.001).

Conclusion

While RSG and LSG are safe with similar mortality, RSG continues to be associated with higher rates of morbidity, leak, and SSI, as well as longer OL, hospital LOS, and higher cost. The study is limited by the ability to account for the impact of surgeon experience and stapler utilization on outcomes.

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Data Availability

Data is from national ACS-MBSAQIP data registry and will not be available.

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Author information

Authors and Affiliations

  1. Department of Surgery, Division of Advanced GI and Bariatric Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA

    Michael A. Edwards, Mark Falstin & Mohammad Alomari

  2. Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center, Mayo Clinic, Jacksonville, FL, 32224, USA

    Aaron Spaulding & Emily R. Brennan

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  1. Michael A. Edwards
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  2. Mark Falstin
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Correspondence to Michael A. Edwards.

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Key Points

• RSG versus LSG was associated with longer operation duration.

• RSG versus LSG was associated with longer hospital stay.

• RSG and LSG had similar mortality rates.

• Leak rate improved over time but remained higher for RSG versus LSG.

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Edwards, M.A., Falstin, M., Alomari, M. et al. Robotic Versus Laparoscopic Sleeve Gastrectomy Outcome Trends Over Time: Are We Improving?. OBES SURG 34, 2596–2606 (2024). https://doi.org/10.1007/s11695-024-07334-x

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