Robotic sleeve gastrectomy vs laparoscopic sleeve gastrectomy: Our preliminary experience and a literature review

Abstract

Aim. Sleeve gastrectomy has gained popularity in recent years and laparoscopic sleeve gastrectomy has become the most common procedure for the treatment of morbid obesity, thanks to its safety, feasibility and good results. Robotic sleeve gastrectomy is an alternative surgical option, but its utilization is still expanding. The aim of this study is to evaluate if there are any differences between the robotic and laparoscopic techniques. Material and methods. From may 2017 to may 2019, 34 patients with pathological obesity were admitted to the Department of Medical and Surgical Sciences, University of Foggia, and we have compared patients undergoing robotic sleeve gastrectomy (RSG) with the group submitted to laparoscopic sleeve gastrectomy (LSG). Results. We analyzed 34 patients underwent sleeve gastrectomy with a mean age of 42.5 years of which 25 were female; 11 treated with robotic approach and 23 with laparoscopic approach. The initial mean body mass index (BMI) was 45.9 kg/m2 and weight 128.7 kg. The mean operative time was 135.9 min for RSG (including docking time) and 107.39 min for LSG (p=0.0449). The median length of stay was 5.38 days, and it is the same for both groups of patients (p=0.89). Mortality and conversions were nil. We reported only 1 case of re-do surgery in a patient underwent to RSG after failure of gastric banding. We observed only 4 cases of post-operative complications: 1 leak treated with surgical approach and 2 bleeding and a port-site infection underwent to medical treatment. Follow-up at 1 month from the recovery in 34 patients has showed an EWL (1) 19.43%: 16.42% for robotic group and 21.64% for laparoscopic one (p=0.1969); follow up at 6 months in 11 patients detected an EWL 44%: 42.75% for robotic group and 46.19% for laparoscopic one (p=0.6951). Discussion. We identified 14 articles describing LSG and RSG as two alternative bariatric procedures, measuring the patients' outcomes and published between 2011 and 2016. The articles included in this study bring us closer to linking the implementation of either method with improved standards of safety, efficiency and cost-effectiveness. The present study demonstrates that RSG and LSG are well-tolerated, feasible and effective surgical approaches. Conclusion. There aren't significant differences between the robotic and laparoscopic groups in terms of length of stay, EWL and complications, except for the mean operative time that is slightly higher in the robotic group and this difference is statistically significant. RSG proved to be a safe and efficient procedur-e, with satisfactory results comparable to LSG. Longer and larger studies are needed for a better comparative evaluation.