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Robotic versus laparoscopic sleeve gastrectomy: a MBSAQIP analysis

  • 2018 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic sleeve gastrectomy has become the procedure of choice for the treatment of morbid obesity. Robotic sleeve gastrectomy is an alternative surgical option, but its utilization has been low. The aim of this study was to evaluate the contemporary outcomes of robotic sleeve gastrectomy (RSG) versus laparoscopic sleeve gastrectomy (LSG) using a national database from accredited bariatric centers.

Study design

Using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, clinical data for patients who underwent RSG or LSG were examined. Emergent and revisional cases were excluded. A multivariate logistic regression model was utilized to compare the outcomes between RSG and LSG.

Results

A total of 75,079 patients underwent sleeve gastrectomy with 70,298 (93.6%) LSG and 4781 (6.4%) RSG. Preoperative sleep apnea and hypoalbumenia were significantly higher in the RSG group (P < 0.01). Mean length of stay was similar between RSG and LSG (1.8 ± 2.0 vs. 1.7 ± 2.0 days, P = 0.17). Operative time was longer in the RSG group (102 ± 43 vs. 74 ± 36 min, P < 0.01). There was no significant difference in 30-day mortality between the RSG versus LSG group (0.02% vs. 0.01%, AOR 0.85; 95% CI 0.11–6.46, P = 0.88). However, RSG was associated with higher serious morbidity (1.1% vs. 0.8%, AOR 1.40; 95% CI 1.05–1.86, P < 0.01), higher leak rate (1.5% vs. 0.5%, AOR 3.14; 95% CI 2.65–4.42, P < 0.01), and higher surgical site infection rate (0.7% vs. 0.4%, AOR 1.55; 95% CI 1.08–2.23, P = 0.01).

Conclusions

Robotic sleeve gastrectomy has longer operative time and is associated with higher postoperative morbidity including leak and surgical site infections. Laparoscopy should continue to be the surgical approach of choice for sleeve gastrectomy.

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Abbreviations

LSG:

Laparoscopic sleeve gastrectomy

RSG:

Robotic sleeve gastrectomy

MBSAQIP:

Metabolic and bariatric surgery accreditation and quality improvement program

BMI:

Body mass index

AOR:

Adjusted odds ratio

CI:

Confidence interval

COPD:

Chronic obstructive pulmonary disease

GERD:

Gastroesophageal reflux disease

DVT:

Deep vein thrombosis

PE:

Pulmonary embolism

OSA:

Obstructive sleep apnea

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Acknowledgements

This research did not receive any specific grant from any funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA

    Reza Fazl Alizadeh, Shiri Li, Colette S. Inaba, Andreea I. Dinicu, Marcelo W. Hinojosa, Brian R. Smith, Michael J. Stamos & Ninh T. Nguyen

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  1. Reza Fazl Alizadeh
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  2. Shiri Li
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  3. Colette S. Inaba
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  4. Andreea I. Dinicu
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  5. Marcelo W. Hinojosa
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  8. Ninh T. Nguyen
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Corresponding author

Correspondence to Ninh T. Nguyen.

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Disclosures

Dr. Fazl Alizadeh, Dr. Li, Dr. Inaba, Ms. Dinicu, and Dr. Hinojosa has nothing to disclose. Dr. Smith discloses that he is an educational consultant for Stryker. Dr. Stamos discloses that he is a consultant for Novadaq. He also discloses that he receives payment for lectures including service on speaker’s bureaus from Novadaq, Ethicon, Medtronic. He has author Royalties for Elsevier. Dr. Nguyen discloses that he receives Honorarium/Speaker Fees from Olympus, Novadaq, Gore, Apollo Endosurgery, and Conmed. There is no conflict of interest with regards to the work of this research for any of the authors (Reza Fazl Alizadeh, Shiri Li, Colette Inaba, Andreea Dinicu, Marcelo Hinojosa, Brian Smith, Michael Stamos, and Ninh Nguyen).

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Fazl Alizadeh, R., Li, S., Inaba, C.S. et al. Robotic versus laparoscopic sleeve gastrectomy: a MBSAQIP analysis. Surg Endosc 33, 917–922 (2019). https://doi.org/10.1007/s00464-018-6387-6

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  • DOI: https://doi.org/10.1007/s00464-018-6387-6

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