Original article30-day outcomes of robot-assisted versus conventional laparoscopic sleeve gastrectomy: First analysis based on MBSAQIP
Section snippets
Methods
The MBSAQIP database is the largest bariatric-specific clinical database in the United States and includes prospective perioperative and 30-day outcomes data for >150,000 annual bariatric cases performed in the United States and Canada in nearly 900 bariatric centers accredited by the American Society for Metabolic and Bariatric Surgery. The participant user file (PUF) contains aggregated data that does not identify hospitals, providers, or patients and is available to all centers that report
Results
After exclusions, 107,726 patients were eligible for analysis (100,341 LSG and 7385 RSG). The average age and preoperative body mass index for all patients were 44.4 years and 46.9 kg/m2, respectively, and did not significantly differ between LSG and RSG (Table 2). Similarly, there were no significant differences in the rate of preoperative co-morbidities (Table 3). Demographic characteristics and co-morbidities were also not significantly different between groups based on method of staple-line
Discussion
SG is now the most commonly performed bariatric surgery in the United States [1]. It has proven to be an effective procedure with low-complication rates and more durable outcomes than medical therapy alone [7], [8]. The use of robotic platforms is growing within bariatric surgery [2]. Some authors advocate for its preferential use in super-morbid obese patients (body mass index >50 kg/m2) due to the reduced tremor and greater range of motion in a potentially smaller field compared with
Conclusion
RSG represents a small but growing percentage of the overall number of SG performed in the United States. According to the MBSAQIP database, the robotic approach demonstrates a significantly higher rate of OSI while trending toward a lower rate of bleeding and 30-day reoperation and intervention. As surgeons continue to adopt and develop new technology, ongoing monitoring and reporting of safety and outcomes data are advised to maintain the high standards for outcomes in bariatric surgery.
Disclosures
The authors have no commercial associations that might be a conflict of interest in relation to this article.
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Feasibility and safety of robot-assisted bariatric conversions and revisions
2020, Surgery for Obesity and Related DiseasesPerioperative Outcomes of Robotic Versus Laparoscopic Sleeve Gastrectomy in the Superobese
2020, Journal of Surgical ResearchCitation Excerpt :Laparoscopic sleeve gastrectomy (LSG) has become the most commonly performed bariatric surgery in the United States owing to its favorable safety profile, technical feasibility, and efficacy in weight loss and comorbidity remission.1-4 Although robotic-assisted approaches have demonstrated overall safety and feasibility in bariatric surgery,5-7 the role of robotic surgery has been questioned owing to increased operative times and higher costs without demonstrable superiority over a laparoscopic approach.8 Patients with a body mass index (BMI) ≥ 50 kg/m2 are categorized as superobese (SO) and present particular challenges related to both surgery and anesthesia because of comorbidities and body habitus.9,10
Robotic Primary and Revisional Bariatric Surgery
2020, Surgical Clinics of North AmericaCitation Excerpt :They demonstrate increased costs and hospital length of stay without differences in other outcomes.47,48 Similarly, analyses of the MBSAQIP database (2015 and/or 2016) demonstrate uniformly longer operative time with the robotic approach to SG.29,41,49,50 No mortality difference has been observed between the 2 approaches in these studies.50
Comment on: cost analysis of assisted robotic sleeve gastrectomy compared to laparoscopic sleeve gastrectomy in a single academic center: debunking a myth
2019, Surgery for Obesity and Related DiseasesCost analysis of robotic sleeve gastrectomy (R-SG) compared with laparoscopic sleeve gastrectomy (L-SG) in a single academic center: debunking a myth!
2019, Surgery for Obesity and Related DiseasesCitation Excerpt :Therefore our present study was designed primarily to evaluate direct variable costs and secondarily to evaluate the outcomes of R-SG versus L-SG. In a previous study we reported that R-SG had a trend toward lower bleeding, 30-day reoperation, and 30-day intervention but a significantly higher organ space infection rate, including staple line leak, compared with L-SG [14]. Therefore our decision to begin performing R-SG was not an attempt to improve outcomes but rather to explore potential benefits of the technology for our patients.