Comprehensive Summary: Robotic Sleeve Gastrectomy Is as Safe as Laparoscopic Sleeve Gastrectomy
Published on: 15 Aug 2025
Introduction
Obesity, a multifactorial disease influenced by genetic, socioeconomic, and cultural factors, is characterized by excessive body fat accumulation, leading to increased risk of comorbidities such as cardiovascular disease, stroke, and type 2 diabetes mellitus. Bariatric surgery has been a transformative intervention for treating morbid obesity for several decades. Traditionally, laparoscopic sleeve gastrectomy (LSG) has been the gold standard due to its advantages, including reduced operative time, shorter hospital stays, and lower mortality rates.
With advances in surgical technology, robotic-assisted surgery has emerged as a new technique offering enhanced precision and control. Robotic sleeve gastrectomy (RSG), first performed in 2000, is gaining popularity, but its safety compared to LSG remains debated. Some earlier studies suggested that robotic surgery might have higher complication rates, potentially making it an inferior option. Given the growing adoption of robotic techniques, this study aims to provide a robust comparison of the safety profiles of RSG versus LSG, focusing on 30-day postoperative complication rates and operative characteristics.
Methods
This study is a retrospective review of prospectively collected data from 927 patients who underwent sleeve gastrectomy (575 RSG and 352 LSG) at a single academic center between June 2021 and August 2023. Patients with prior bariatric surgery or under 18 years old were excluded. Baseline patient characteristics, operative details, and 30-day postoperative complications were analyzed.
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Surgical Techniques:
- LSG: Utilized four laparoscopic ports with a Nathanson liver retractor and Medtronic LigaSure™ device to mobilize the greater curvature. A 40-Fr bougie guided the sleeve creation with an Ethicon Echelon™ stapler. Staple-line reinforcement was routine, using Gore SeamGuard® and Baxter Tisseel fibrin sealant.
- RSG: Performed using the Intuitive da Vinci Xi® platform with four abdominal trocars and the Intuitive Vessel Sealer Extend™ device. A similar bougie size was used. Stapling was done with an Intuitive SureForm™ stapler without staple-line reinforcement; Baxter Tisseel was applied similarly.
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Statistical Analysis: The study used multiple logistic regression models adjusting for baseline factors (sex, age, BMI, hyperlipidemia), operative characteristics (ASA class, operative time, staple-line reinforcement), and calendar date to account for learning curve effects. A power analysis confirmed sufficient sample size to detect a ≥5% absolute difference in complication rates with ≥80% power. Missing data were minimal (<1.8%) and handled by complete-case analysis.
Results
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Baseline Characteristics: The two patient groups were comparable in age (mean ~40 years), BMI (mean ~43 kg/m²), and comorbidities, with a slight difference in sex distribution favoring females in the RSG group (77% vs. 70%) [[3]][[4]].
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Operative Characteristics: Median operative time was modestly longer for RSG (73 minutes) compared to LSG (66 minutes), a statistically significant but clinically minor difference (<10% increase). Length of stay (LOS) was similarly slightly longer for RSG by approximately 0.04 days (~58 minutes), again statistically significant but not clinically meaningful [[3]][[4]].
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Complication Rates: The overall 30-day complication rate was 3.5%, identical between RSG (3.5%) and LSG (3.4%). The median day of complication onset was postoperative day 9. Multivariable logistic regression, adjusting for all baseline and operative variables, confirmed no statistically significant difference in complication rates between RSG and LSG (adjusted odds ratio [OR] = 1.00; 95% confidence interval [CI] 0.43–2.35; p = 0.998). This indicates that robotic surgery is as safe as laparoscopic surgery within 30 days post-operation [[3]][[4]][[7]].
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Learning Curve Analysis: Calendar date was included as a covariate to account for surgeon experience over time. No residual learning curve effect was detected on complication rates, suggesting surgeons had overcome the initial phase of robotic technique adoption. The complication rate for RSG decreased from 8% in 2021 to 2.5% in 2022-2023, supporting this conclusion [[4]][[6]].
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Factors Associated with Complications: Hyperlipidemia was the only baseline characteristic significantly associated with increased complications, especially in the robotic group. No operative factors, including ASA class, operative time, or staple-line reinforcement, were significantly linked to complications.
Discussion
This large, detailed study examined 45 variables across nearly a thousand patients, performing rigorous statistical adjustments to ensure unbiased comparisons. The findings align with larger multicenter studies and recent meta-analyses showing no clinically significant difference in early morbidity, leak, or bleed rates between robotic and laparoscopic sleeve gastrectomy.
The slightly longer operative time and LOS for RSG are not clinically meaningful and may reflect the ongoing learning curve during the study period. Given that operative times tend to decrease as surgeons become more experienced, current robotic operative times may approximate laparoscopic durations.
Robotic surgery, initially favored for super-obese patients, appears increasingly utilized across a broad range of BMI categories, reflecting its versatility and potential benefits beyond complex cases.
Key limitations include the retrospective nature of the study, relatively low complication rates requiring even larger cohorts to detect modest differences, and data collection overlapping with the COVID-19 pandemic, which may have affected outcomes. Despite these, the study’s thorough methodology and comprehensive variable adjustment strengthen confidence in its conclusions.
Conclusions
Robotic sleeve gastrectomy is as safe as laparoscopic sleeve gastrectomy regarding 30-day postoperative complications, with no significant difference detected after adjusting for patient and operative variables. The minor increases in operative time and length of stay for robotic surgery are statistically significant but clinically negligible.
The decline in robotic complication rates over time suggests that surgeons are mastering the technique, and ongoing technological advances may further improve outcomes. However, larger multicenter studies with longer follow-up and cost analyses are needed to confirm these findings and explore long-term implications.
As robotic surgery becomes more prevalent, continued research will be essential to optimize bariatric surgical care and patient outcomes.
SOURCE/READ THE FULL ARTICLE: https://pubmed.ncbi.nlm.nih.gov/40813834/
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