Tuesday, July 16, 2024

Robotic vs. Laparoscopic Sleeve Gastrectomy: A Comparative Study of Outcomes

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With the rise in obesity, the healthcare sector has been exploring innovative surgical techniques to enhance patient outcomes. One such innovation is robotic sleeve gastrectomy (RSG), which has seen a significant increase in utilization over recent years. A recent study sheds light on the clinical outcomes of RSG compared to the traditional laparoscopic sleeve gastrectomy (LSG), emphasizing the role of stapler types in influencing these results.

Study Overview

The study, conducted using the PINC AI Healthcare Database, analyzed elective LSG and RSG procedures performed between January 1, 2019, and December 31, 2021. This comprehensive dataset included detailed patient, hospital, billing, provider, insurance, and operative information. To compare the outcomes accurately, the study employed propensity score matching (PSM) to evaluate RSG procedures using the SureForm stapler against LSG procedures using powered staplers.

Key Findings

A total of 56,013 LSG and 13,832 RSG cases were scrutinized. The study revealed that the percentage of RSG procedures increased from 15% in 2019 to 25% in 2021, with a notable 27% rise in the use of robotic staplers for these surgeries. The PSM analysis, which included 5,434 RSG cases with the SureForm stapler and an equal number of LSG cases with powered staplers, found that the complication rates between RSG and LSG were equivalent. However, RSG was associated with shorter lengths of stay (LOS) but required longer operative times.

The research underlines the importance of considering stapler types when evaluating surgical outcomes. The equivalence in complication rates between RSG and LSG, despite the difference in stapler technology, suggests that RSG is a viable alternative to LSG, offering similar patient safety and effectiveness.

Market Access Implications

Key Inferences:

  • The rise in RSG adoption reflects growing confidence in robotic technologies, potentially increasing market demand for advanced surgical instruments.
  • The equivalent outcomes between RSG and LSG, when accounting for stapler type, may lead to broader insurance coverage and reimbursement policies for RSG procedures.
  • Healthcare providers may need to invest in training and infrastructure to accommodate the rising preference for robotic surgeries.

In conclusion, the study demonstrates that when stapler type is considered, the patient outcomes for RSG and LSG are comparable. This insight is crucial for healthcare providers and policymakers, as it underscores the potential of RSG as a standard treatment option for severe obesity, ensuring safe and effective care for patients.

Original Article:

Am J Surg. 2024 Jun 13:115801. doi: 10.1016/j.amjsurg.2024.115801. Online ahead of print.


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BACKGROUND: Sleeve gastrectomy (SG) remains a safe and effective treatment for severe obesity. The number of robotic SG (RSG) has steadily increased from 2015 to 2021. Prior studies have shown higher rates of some adverse outcomes with RSG but have not accounted for staplers used.

OBJECTIVE: The aim of this study is to compare outcomes for RSG compared to laparoscopic sleeve gastrectomy (LSG), accounting for stapler type used.

SETTING: National hospital derived administrative data.

METHODS: The PINC AI Healthcare Database was used for the current study. Analyzed cohort included elective LSG or RSG performed between January 1, 2019, and December 31, 2021. Patient, hospital, billing, provider, insurance, and operative data were captured. Bleeding, leak, and other outcomes were identified by ICD-10-CM diagnosis codes. Propensity score matching (PSM) compared outcomes between RSG with SureForm stapler vs. LSG with powered stapler.

RESULTS: 56,013 LSG and 13,832 RSG were analyzed. RSG increased from 15 % in 2019 to 25 % in 2021 with an absolute 27 ​% increase in robotic stapler utilization for RSG. PSM analysis compared, 5434 RSG with SureForm Stapler vs. 5434 LSG with powered staplers showed equivalent complication rates, shorter LOS, but longer operative time with RSG.

CONCLUSIONS: When stapler type used is accounted for, patient outcomes following RSG and LSG are equivalent.

PMID:38944623 | DOI:10.1016/j.amjsurg.2024.115801

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