Comparing the effect of laparoscopic and robotic stapling on clinical outcomes, efficiency, and costs of robot-assisted Roux-en-Y gastric bypass.

Abstract

Roux-en-Y gastric bypass (RYGB) is a commonly used surgery to successfully and durably treat obesity that is increasingly performed robotically. The anastomoses created during robot-assisted RYGB are usually stapled, either using laparoscopic or robotic staplers. This study aimed to compare the peri-operative efficiency, costs, and clinical outcomes of laparoscopic and robotic staplers in robot-assisted RYGB. This retrospective study analyzed patients who underwent robot-assisted RYGB (with or without hiatal hernia repair) with the Da Vinci Xi robotic system in a private practice in the United States. The gastric pouch and anastomoses were created either with robotic SureForm™ staplers or laparoscopic Endo GIA™ staplers; enterotomies and incisions were closed with sutures. The primary outcome was procedure time. The secondary outcomes were instrument exchanges and reloads used, stapling costs, length of stay, and complications within 3 months. Of the 105 patients included, 50 patients were treated with robotic staplers and 55 with laparoscopic staplers. None were lost to follow-up. Laparoscopic staplers were more efficient than robotic ones: they significantly reduced procedure times across all analyzed categories as well as the number of instrument exchanges and reloads needed per surgery. There was no difference in the length of hospital stay, and no complications were reported. The higher number of reloads and the higher unit cost resulted in higher total stapling costs for robotic compared to laparoscopic staplers. While robotic staplers in robot-assisted RYGB are safe and feasible, laparoscopic staplers improve efficiency, reduce resource use, and lower costs without compromising patient safety.