Affolter Jan, Mühlhäusser Julia, Marengo Michele, Garofalo Fabio, Gass Jörn-Markus, Mongelli Francesco
Department of Surgery, Luzerner Kantonsspital, 6000, Lucerne, Switzerland.
Department of Surgery, Ospedale Regionale di Locarno, EOC, 6600, Locarno, Switzerland.
Surg Endosc. 2025 May;39(5):2784-2798. doi: 10.1007/s00464-025-11744-y. Epub 2025 Apr 21.
Bariatric surgery is currently the most effective approach to addressing severe obesity and reducing related health issues. Laparoscopy remains the standard technique, whereas robotic-assisted surgery is increasingly adopted, although its role in bariatric surgery remains debated. The main criticism concerns its higher costs and the lack of evidence demonstrating improved clinical outcomes compared to other treatment methods. We aimed to compare the costs of robotic-assisted and laparoscopic bariatric surgery through a systematic review and meta-analysis.
Following PRISMA reporting guidelines, a literature search was conducted in PubMed, Cochrane Library, Web of Science, and Google Scholar for studies comparing robotic-assisted and laparoscopic bariatric surgery. The primary outcome was total hospital costs, with bias assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Effect sizes were calculated with 95% confidence intervals, and an overall effect was estimated using a random-effects model.
A total of 14 retrospective studies (293 articles screened) were included, with 1,414,357 patients (112,363 robotic; 1,301,994 laparoscopic). Total hospital costs favored laparoscopic surgery (SMD 0.721, 95%CI: 0.555-0.887, p < 0.001, absolute difference USD 3819). Operating room costs also favored laparoscopy (SMD 1.339, 95%CI 0.202-2.476, p = 0.021, absolute difference: USD 9746). Laparoscopy was associated with shorter operative time, while robotic surgery showed a slight advantage in hospital stay and complication rates. Subgroup and sensitivity analyses were consistent with the main findings. The quality of evidence was rated as low due to potential biases.
Our systematic review and meta-analysis provides the most current and robust evidence indicating that the robotic-assisted approach incurs significantly higher costs than the laparoscopic approach in bariatric surgery. This finding remained consistent across the overall analysis as well as in nearly all subgroup and sensitivity analyses. Randomized controlled trials are warranted to accurately evaluate the cost-effectiveness of the robotic approach in both primary and revisional bariatric procedures.
减肥手术是目前治疗重度肥胖及减少相关健康问题的最有效方法。腹腔镜手术仍是标准术式，而机器人辅助手术的应用日益广泛，但其在减肥手术中的作用仍存在争议。主要批评意见涉及该手术成本较高，且缺乏证据表明与其他治疗方法相比其临床效果有所改善。我们旨在通过系统评价和荟萃分析比较机器人辅助减肥手术和腹腔镜减肥手术的成本。
按照PRISMA报告指南，在PubMed、Cochrane图书馆、科学网和谷歌学术中检索比较机器人辅助减肥手术和腹腔镜减肥手术的研究。主要结局为总住院费用，使用干预性非随机研究的偏倚风险（ROBINS-I）工具评估偏倚。计算效应量及其95%置信区间，使用随机效应模型估计总体效应。
共纳入14项回顾性研究（筛选293篇文章），涉及1,414,357例患者（112,363例接受机器人辅助手术；1,301,994例接受腹腔镜手术）。总住院费用方面，腹腔镜手术更具优势（标准化均数差0.721，95%置信区间：0.555 - 0.887，p < 0.001，绝对差值3819美元）。手术室费用同样支持腹腔镜手术（标准化均数差1.339，95%置信区间0.202 - 2.476，p = 0.021，绝对差值：9746美元）。腹腔镜手术的手术时间较短，而机器人手术在住院时间和并发症发生率方面略有优势。亚组分析和敏感性分析结果与主要发现一致。由于存在潜在偏倚，证据质量被评为低质量。
我们的系统评价和荟萃分析提供了最新且有力的证据，表明在减肥手术中，机器人辅助手术的成本显著高于腹腔镜手术。这一发现贯穿于整体分析以及几乎所有亚组分析和敏感性分析中。需要进行随机对照试验，以准确评估机器人手术在初次及翻修减肥手术中的成本效益。
