Robotic Versus Laparoscopic Sleeve Gastrectomy for Morbid Obesity: A Meta-Analysis

Background: Sleeve gastrectomy (SG) represents the fastest growing bariatric surgical procedure and has been associated with few long term complications. SG provides the opportunity to act as a bridge for future procedures in the super obese, improving comorbidities before laparoscopic Roux-en-Y gastric bypass (RYGB). With the technological advancement in minimally invasive surgery, many surgeons have adopted the robotic technique. The purpose of this meta-analysis was to compare the clinical safety and efficacy of robotic sleeve gastrectomy (RSG) with laparoscopic sleeve gastrectomy (LSG). Methods: A MEDLINE database search was performed and selected studies included those in which RSG and LSG were compared in terms of perioperative outcomes. Evaluated variables included operative time, perioperative bleeding, length of stay, stricture formation, leak rate, and mean BMI after one year. Results: Four studies matched the selection criteria and reported on a total of 3599 sleeve gastrectomy cases. Of these, 280 cases were RSG and 3319 were LSG. Comparing RSG to LSG, we found favorable outcomes in regards to mean BMI after one year (SMD: -0.243; 95% CI: -0.466-0.019; p = 0.033). However, operative time was increased (SMD: 0.602; 95% CI: 0.417-0.788; p < 0.01). Other results were not significant, including leak rate (RR: 0.433; 95% CI: 0.115-1.638; p = 0.218); perioperative bleeding (RR: 0.578; 95% CI: 0.161-2.075; p = 0.401); stricture formation (RR: 1.809; 95% CI: 0.249-13.132; p = 0.558); and length of stay (SMD: -0.078; 95% CI: -0.260-0.105; p = 0.404). Conclusions: Robotic sleeve gastrectomy as compared to LSG shows a significantly increased operative time. In regards to mean BMI at one year, RSG is superior to LSG. There was no significant difference in LOS, perioperative bleeding, leak rate, or stricture formation. RSG is a safe and feasible alternative to conventional LSG [1-4].