Sleeve Gastrectomy for Morbid Obesity: Robotic vs Standard Laparoscopic Sleeve Gastrectomy Methods

Abstract

Aim:The aim of this study is to compare robotic laparoscopic sleeve gastrectomy with standard laparoscopic sleeve gastrectomy done for morbid obesity with regards to operative time and short-term patient outcome in a developing world.Background: Excision of the fundus and greater curvature of the stomach in sleeve gastrectomy not only restrict intake but also reduces the level of ghrelin in the circulating blood. Obesity surgery has benefited from the advent of surgical robot with its celebrated advantages (enhanced dexterity, precision and control of endowrist instruments, with 7º of freedom, 90º of articulation, intuitive motion and finger-tip control, motion scaling and tremor reduction). How this new technology under development affect patient outcome has only been reported in a few centers especially in the developed world. Materials and methods:Data for 21-month retrospective comparative study was collected from the records of 20 adult patients who had robotic sleeve gastrectomy (RSG) and 20 standard laparoscopic sleeve gastrectomy (SLSG) (obtained by randomized sampling of the total number of SLSG during the study period).Results and discussion: Duration of surgery, cost of operation, duration of hospital stay, percentage excess weight loss (%EWL)/BMI, quality of life, comorbidity resolution and complications were the measures of outcome studied in comparing RSG to SLSG. The mean duration of surgery of 143.05 minutes for SLSG and 152.7 minutes RSG (ratio 1:1.07) were in agreement with previous studies in which the duration of RSG was longer than SLSG. The RSG mean docking time of 12.6 minutes in this study obviously contributed to increasing the total operative time.The cost of surgery was found to be higher RSG 9000 USD compared to 7500 USD for SLSG (ratio1.2:1). This value is relatively higher than that documented in a study in which 400 euros was quoted. Understandably, this varied from center to center. Three patients (15%) were observed to have some significant complications among the SLSG group as against one patient (5%) in the RSG group. Conclusion:Sleeve gastrectomy by robotic method in a developing country experience, has comparative advantage over standard laparoscopic methods in reducing complications, though the duration and cost of surgery were higher in the WJOLS robotic methods. The choice of the method would therefore depend on availability, surgeon's skills, the patient's informed choice and ability to afford.

Systematic review of operative outcomes of robotic surgical procedures performed with endoscopic linear staplers or robotic staplers

“…Robotic surgery performed with ELS is generally referred to as an advanced surgical technique for multiple types of procedures, including gastric bypass [ 10 – 12 , 28 ], sleeve gastrectomy [ 12 – 15 ], liver resection [ 18 , 19 , 30 , 31 ], colorectal surgery [ 20 – 24 , 32 – 34 ], thoracic surgery [ 25 ], nephrectomy [ 26 , 35 ], pancreatectomy [ 27 ], bladder surgery [ 34 ], and prostate surgery [ 36 ]. These procedures typically take longer than laparoscopic or open surgery [ 10 , 11 , 13 , 14 , 18 ], but have comparable or lower complication rates and/or more favorable perioperative outcomes [ 11 – 14 , 25 , 27 , 36 ]. In these studies, stapling was typically performed by an assistant laparoscopic surgeon, and it was generally reported that although technically demanding, surgical procedures performed with the da Vinci robotic system or ELS are practical and safe.…”