Use of Lower Staple Heights in Robotic Sleeve Gastrectomy: National Trends and Impact on Outcomes

This study aimed to characterize SureForm stapler usage trends in robotic sleeve gastrectomy (RSG) and compare associated outcomes, accounting for staple height used.

The proportion of sleeve gastrectomy cases done robotically is increasing, but uncertainty remains about optimal stapler choice, reload height and reinforcement, and the impact of these choices on perioperative outcomes.

Elective laparoscopic and robotic SG performed from January 1, 2019, to February 28, 2023, were identified in the PINC AI Healthcare Database. Patients who underwent RSG were included. RSG with no stapler type/height information was excluded. The incidences of complications such as bleeding, leak, and sepsis in the perioperative period were evaluated using International Classification of Diseases/Current Procedure Terminology codes. Hospital resource utilization data such as length of stay, operative time, intensive care unit utilization, and readmission were also analyzed. Propensity score matching (PSM) analysis was used to compare outcomes.

A total of 35,795 RSG were analyzed with 23,904 documenting use of SureForm stapler. Use of at least one SureForm white reload increased from 19.2% to 52.7% in the study period; use of 3 or more white reloads per case increased from 6% to 71%. PSM analysis compared 5795 RSG with any white reload versus 5795 RSG with non-white reloads, showing equivalent complication rates, marginally shorter length of stay, and longer operative time with white reloads.

There is a trend toward downsizing to white stapler reloads in RSG without significant changes in perioperative outcomes and minor differences in hospital resource utilization. These findings suggest that white stapler reload use is safe in RSG.