Robotic Sleeve Gastrectomy Is as Safe as Laparoscopic Sleeve Gastrectomy

Robotic sleeve gastrectomy (RSG) is increasingly used in bariatric surgery, but its safety compared to laparoscopic sleeve gastrectomy (LSG) remains debated.

We retrospectively reviewed electronic medical records of 927 (575 RSG, 352 LSG) patients at a single academic center from June 2021 to August 2023. The baseline and operative characteristics of the study groups were compared using two-sample t tests, Wilcoxon rank-sum tests, chi-square tests, and Fisher's exact tests. Thirty-day complication rates were compared using multiple logistic regression, adjusted for baseline factors, operative characteristics, ASA class, and staple-line reinforcement. Statistical analysis was conducted using SAS 9.4, and p-values < 0.05 were considered significant. Logistic regression was used to evaluate whether complication rates were different between RSG and LSG while adjusting for other factors.

Five hundred seventy-five patients underwent RSG, and 352 underwent LSG. The average body mass index (BMI) was 43.05 kg/m² (RSG 43, LSG 43.12, p = 0.806), average age 39.8 (RSG 39.3, LSG 40.7, p = 0.084), and 74% were females (RSG 75%, LSG 69.8%, p = 0.032). Baseline characteristics were comparable between the two groups. Median operative time was 73 min for RSG vs 66 min for LSF (p = 0.0002). Thirty-day complication rates were 3.5% in both groups (adjusted OR = 1.00, 95% CI 0.43-2.35, p = 0.998). Quarterly analysis and CUSUM demonstrated no residual learning-curve effect on complications. Power analysis confirmed ≥ 80% power to detect a ≥ 5% absolute difference. Missing-data sensitivity analyses corroborated primary findings.

RSG is as safe as LSG within 30 days, with a modest 7-min operative-time penalty that is unlikely to be clinically meaningful.