Background

Technological innovations are often utilized before data demonstrates value. There is constant increase in use of robotic system for sleeve gastrectomy(SG) even for patients without prior surgery. Robotic surgery has many proposed advantages, including visualization and articulated instruments. However, the value of the robot has not been demonstrated in SG or bariatric surgery. The aim of this study is to analyze the trend and compare the value of robotic SG(RSG) to laparoscopic SG(LSG).

Methods

MBSAQIP 2015-2020 Was the data source. Patients who underwent SG without previous foregut or concurrent surgery were identified to select the ideal surgical candidates. Temporal trend was assessed with Mann–Kendall tests for Sen’s slope(SS) and repeated measures ANOVAs. Logistic regression models were used to correct for confounders and outcomes for 30-day mortality, leak, ICU admission, sepsis, readmission, and conversion to open. Linear regression evaluated OR time, hospital stay, and transfusion.

Results

707,531 patients were identified. 637,485 LSG(90.1%) and 70,046 RSG(10.9%). RSG increased over time from 6.34% (7,036) to 17.52% (20,746) (p<0.001, SS: 0.57). Regression models correcting for confounders showed, no difference in mortality (p=0.22), hospital-stay (p=0.12), leak (p=0.28), re-operation (p=0.06), transfusion (p=0.06), readmission (p=0.08), ICU (p=0.63), and sepsis (p=0.14). Conversion was higher for RSG (0.37% vs 0.11%, OR 1.41, 95% CI:1.34-1.58, p<0.001). RSG was also associated with increased operative time (99.1 vs 69.1 min, p<0.001).

Conclusions

Although RSG had similar perioperative outcomes, it had longer operative times and higher conversion rates. These findings suggest that RSG does not add value to outcomes in SG.