Robotic systems are the next leap forward in minimally invasive surgery through improved surgical ergonomics. Bariatric surgery is increasingly complex and has the potential to benefit from incorporating the robotic platform. The sleeve gastrectomy is considered an ideal procedure for introducing the robot to a bariatric surgical service.
With increasing health costs, prioritising interventions that are cost effective and have evidence of clinical benefit is paramount. The international evidence for robotic surgery in the bariatric setting is variable. Reported downsides of robotic surgery are inflated costs and prolonged operative times. There is no Australian data analysing the cost of robotic bariatric surgery. A detailed cost-analysis assists both individual surgeons and institutions in future planning to adopt new technology. This study aims to review for differences in outcomes and cost between the two procedures.
This is a retrospective analysis of a single surgeon’s laparoscopic and robotic sleeve gastrectomies. 285 consecutive laparoscopic sleeve gastrectomes from 2017 to 2019 and 85 consecutive robotic sleeve gastrectomies from 2014 to 2019 were included. This includes the initial learning curve for implementing the robot. Patients were selected for robotic surgery based on the availability of the robot. Demographics and pre-operative BMI were similar in the two groups. Median operative time including robot docking was shorter in the robotic group (60 mins vs 111 mins). There was no difference in stapler firings or post-operative complications. However, mean length of stay was 3 days for the robot group compared to 2 days for the laparoscopic group. A complete cost analysis is being performed in collaboration with the hospital financial department. This comparison supports the safe application of robotic technology in sleeve gastrectomy with potential improvements in operative time. Cost-analysis can be used to colour discussion of robotic sleeve gastrectomy implementation in Australian centres.