RESUMO
BACKGROUND: Few studies have evaluated the use of laparoscopic staplers in robotic procedures (bedside stapling, BS). This study aims to evaluate the effectiveness of BS compared with robotic staplers (RS) in bariatric robotic procedures. METHODS: Patients who underwent robotic sleeve gastrectomy or gastric bypass elective procedures between 1/1/2021 and 12/31/2021 were extracted from PINC AI™ Healthcare Data. The following clinical outcomes were compared: blood transfusion, bleeding, anastomotic leak, intensive care unit (ICU) visit, and 30-day readmission, operating room (OR) time, inpatient costs, and length of stay. We evaluated baseline balance in BS and RS and bivariate association between covariates and outcomes using Chi-square or Fisher exact test and t-test or ANOVA. Multivariable general linear mixed models (GLMMs) with respective gamma or binomial distribution and log-link function were used to obtain adjusted outcomes variations between BS and RS. RESULTS: Total of 7268 discharges were included with 1603 (22.1%) BS and 5665 (77.9%) RS cases. RS cases consisted of a higher number of patients who were Hispanic (17.0% vs. 9.4%), had Medicaid (26.9% vs. 19.4%) and underwent sleeve gastrectomy (68.4% vs. 53.5%). Higher proportions of RS cases were done by providers in Northeast region (35.5% vs. 24.3%), smaller size (< 500 beds; 71.1% vs. 52.3%), and teaching hospitals (59.4% vs. 39%). The adjusted outcomes variations demonstrated that patients that had RS were significantly more likely to have blood transfusions, ICU stays, increased ORT (19 min) and costs ($1273). Sensitivity analysis showed similar results, except no significant differences in blood transfusion rates in both groups. CONCLUSIONS: Bedside staplers significantly reduce healthcare resource utilization with equivalent effectiveness and fewer ICU stays compared to robotic staplers.
RESUMO
BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has a reported learning curve of 100 cases. Robotic-assisted surgery decreases the learning curve in complex laparoscopic surgeries. We hypothesize that robotic-assisted, hand-sewn gastrojejunostomy during a LRYGB will improve results during the initial 100 cases when compared with the literature. METHODS: Our first 100 robotic-assisted gastrojejunostomies performed during LRYGB were reviewed from a prospective database. Patient demographics, operative times, length of stay, reoperations, anastomotic leak, pulmonary embolus, and death were all evaluated. RESULTS: The mean age and body mass index were 42 and 50, respectively. Operative times ranged from 148 minutes to 437 minutes (mean = 254). There were no leaks or deaths. Four patients had complications, including reoperation (1), incisional hernia (1), pulmonary embolus (1), and recurrent umbilical hernia (1). CONCLUSIONS: Robotic-assisted LRYGB is feasible and safe, as evidenced by the excellent outcomes from this series during the initial learning curve for LRYGB.
