Hung Kay S, Lee Shih-Hao, Azagury Dan E, Ruhle Brian, Wall James K, White Lee, Zheng Feibi, Esquivel Micaela M
From the Department of Surgery, Stanford University School of Medicine, Stanford, CA.
Intuitive Surgical, Sunnyvale, CA.
Ann Surg Open. 2025 Apr 24;6(2):e570. doi: 10.1097/AS9.0000000000000570. eCollection 2025 Jun.
This study aimed to characterize SureForm stapler usage trends in robotic sleeve gastrectomy (RSG) and compare associated outcomes, accounting for staple height used.
The proportion of sleeve gastrectomy cases done robotically is increasing, but uncertainty remains about optimal stapler choice, reload height and reinforcement, and the impact of these choices on perioperative outcomes.
Elective laparoscopic and robotic SG performed from January 1, 2019, to February 28, 2023, were identified in the PINC AI Healthcare Database. Patients who underwent RSG were included. RSG with no stapler type/height information was excluded. The incidences of complications such as bleeding, leak, and sepsis in the perioperative period were evaluated using International Classification of Diseases/Current Procedure Terminology codes. Hospital resource utilization data such as length of stay, operative time, intensive care unit utilization, and readmission were also analyzed. Propensity score matching (PSM) analysis was used to compare outcomes.
A total of 35,795 RSG were analyzed with 23,904 documenting use of SureForm stapler. Use of at least one SureForm white reload increased from 19.2% to 52.7% in the study period; use of 3 or more white reloads per case increased from 6% to 71%. PSM analysis compared 5795 RSG with any white reload versus 5795 RSG with non-white reloads, showing equivalent complication rates, marginally shorter length of stay, and longer operative time with white reloads.
There is a trend toward downsizing to white stapler reloads in RSG without significant changes in perioperative outcomes and minor differences in hospital resource utilization. These findings suggest that white stapler reload use is safe in RSG.
本研究旨在描述SureForm吻合器在机器人袖状胃切除术（RSG）中的使用趋势，并比较相关结果，同时考虑所使用的吻合器高度。
机器人辅助进行袖状胃切除术的病例比例正在增加，但对于最佳吻合器选择、再装填高度和加固方式，以及这些选择对围手术期结果的影响仍存在不确定性。
在PINC AI医疗数据库中识别出2019年1月1日至2023年2月28日期间进行的择期腹腔镜和机器人辅助袖状胃切除术。纳入接受RSG的患者。排除未提供吻合器类型/高度信息的RSG病例。使用国际疾病分类/当前手术操作术语代码评估围手术期出血、渗漏和败血症等并发症的发生率。还分析了住院时间、手术时间、重症监护病房使用情况和再入院等医院资源利用数据。采用倾向评分匹配（PSM）分析比较结果。
共分析了35795例RSG病例，其中23904例记录使用了SureForm吻合器。在研究期间，至少使用一次SureForm白色再装填的比例从19.2%增加到52.7%；每例使用3次或更多白色再装填的比例从6%增加到71%。PSM分析比较了5795例使用任何白色再装填的RSG与5795例使用非白色再装填的RSG，结果显示并发症发生率相当，使用白色再装填的住院时间略短，手术时间更长。
在RSG中，有向使用白色吻合器再装填小型化的趋势，围手术期结果无显著变化，医院资源利用存在微小差异。这些发现表明，在RSG中使用白色吻合器再装填是安全的。
