van Boxel Gijs I, Straatman Jennifer, Carter Nicholas C, Glaysher Michael A, Fajksova Veronika
Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
J Robot Surg. 2025 May 2;19(1):193. doi: 10.1007/s11701-025-02348-8.
Minimally invasive sleeve gastrectomy as a treatment for individuals living with severe obesity remains the most common operation in bariatric and metabolic surgery. With the introduction of robotic-assisted surgery, an increasing proportion of sleeve gastrectomies are performed using the da Vinci robotic surgical platform. To date, the evidence to support or contest this practice is still unclear although meta-analyses have shown safety and feasibility. Here we present a prospective cohort study comparing 101 consecutive patients who had either robotic-assisted or laparoscopic sleeve gastrectomy for obesity. Short-term outcomes, including length of stay and thirty-day complication rates, as well as the total consumable cost for both the laparoscopic and robotic-assisted procedures were collected. We also assessed the learning curve associated with robotic-assisted sleeve gastrectomy. The cohort had similar baseline characteristics in terms of BMI and co-morbidity. The mean operative time, post-operative CRP and complication rates were the same in both groups. Length of stay was statistically shorter for the robotic-assisted cohort in comparison to the laparoscopic cohort; 1.3 days versus 1.9 days, respectively (p < 0.005). The percentage of patients requiring only a single night admission was significantly higher at 82% in the robotic-assisted group, compared to 32% in the laparoscopic group (p < 0.005); in the context of a nurse-led-discharge protocol. Total consumable cost was significantly lower in the robotic group at an average of £2310, compared to £2665 in the laparoscopic group (p < 0.001). The learning curve for the procedure was found to be 26 cases, predominantly driven by the resectional component of the procedure. Robotic-assisted sleeve gastrectomy on the 4th generation da Vinci system utilising robotic advanced energy and Sureform stapling is safe and effective. This cohort study suggests that using the robotic platform is favourable in terms of overall consumable cost and may reduce length of stay. In the context of previous robotic experience, the observed learning curve is relatively short.
微创袖状胃切除术作为治疗重度肥胖患者的方法，仍然是减肥和代谢手术中最常见的术式。随着机器人辅助手术的引入，越来越多的袖状胃切除术是使用达芬奇机器人手术平台进行的。尽管荟萃分析已显示其安全性和可行性，但迄今为止，支持或反对这种做法的证据仍不明确。在此，我们进行了一项前瞻性队列研究，比较了101例因肥胖接受机器人辅助或腹腔镜袖状胃切除术的连续患者。收集了短期结局，包括住院时间和30天并发症发生率，以及腹腔镜和机器人辅助手术的总耗材成本。我们还评估了与机器人辅助袖状胃切除术相关的学习曲线。该队列在BMI和合并症方面具有相似的基线特征。两组的平均手术时间、术后CRP和并发症发生率相同。与腹腔镜队列相比，机器人辅助队列的住院时间在统计学上更短；分别为1.3天和1.9天（p<0.005）。在护士主导的出院方案背景下，仅需住院一晚的患者百分比在机器人辅助组显著更高，为82%，而腹腔镜组为32%（p<0.005）；机器人组的总耗材成本显著更低，平均为2310英镑，而腹腔镜组为2665英镑（p<0.001）。发现该手术的学习曲线为26例，主要由手术的切除部分驱动。使用机器人高级能量和Sureform吻合器的第四代达芬奇系统进行机器人辅助袖状胃切除术是安全有效的。这项队列研究表明，就总体耗材成本而言，使用机器人平台是有利的，并且可能缩短住院时间。在有先前机器人手术经验的背景下，观察到的学习曲线相对较短。
