Summary of ‘Comparing the effect of laparoscopic and robotic stapling on clinical outcomes, efficiency, and costs of robot-assisted Roux-en-Y gastric bypass’
The increasing prevalence of obesity worldwide has made metabolic bariatric surgery (MBS) an essential intervention for effective weight management. Among the various surgical procedures, Roux-en-Y gastric bypass (RYGB) stands out as a popular choice, accounting for a significant percentage of MBS cases globally. The advent of robotic-assisted surgery has transformed the approach to RYGB, allowing for greater precision. However, the comparative efficacy of robotic staplers versus traditional laparoscopic staplers in terms of clinical outcomes, efficiency, and costs remains a pivotal area of investigation.
Study Objectives
This retrospective study aimed to analyse the perioperative efficiency, costs, and clinical outcomes associated with the use of robotic SureForm™ staplers compared to laparoscopic Endo GIA™ staplers during robot-assisted RYGB procedures.
Methodology
Conducted at Grinnell Regional Medical Centre in Iowa, USA, the study involved 105 patients who underwent robot-assisted RYGB, with or without hiatal hernia repair, between May 2022 and November 2023. Of these, 50 patients were treated with robotic staplers while 55 received laparoscopic staplers. The primary outcome measured was the procedure time, while secondary outcomes included instrument exchanges, reloads utilized, stapling costs, length of hospital stay, and complications within three months of surgery.
Results
Procedure Efficiency
The study revealed that laparoscopic staplers significantly improved surgical efficiency. Specifically, the use of laparoscopic staplers reduced the operating room (OR) time from 124.24 ± 26.98 minutes to 106.62 ± 28.97 minutes (p = 0.0017). Similarly, console time and active time were notably less in the laparoscopic group, indicating a more streamlined process. The number of instrument exchanges and reloads were also lower for laparoscopic staplers compared to their robotic counterparts, which resulted in decreased overall procedure times.
Clinical Outcomes
Despite the efficiency gains, the length of hospital stays remained comparable between the two groups, averaging around 1.20 ± 0.45 days for robotic staplers and 1.11 ± 0.31 days for laparoscopic staplers (p = 0.2308). Importantly, no intra-operative or post-operative complications were reported in either group, indicating that both stapling techniques maintained patient safety.
Cost Analysis
The financial implications of using robotic staplers were significant. The unit cost of the robotic stapler handle was USD 451 more expensive than that of the laparoscopic stapler handle. Furthermore, robotic staplers required more reloads per patient, leading to total stapling costs of USD 2,175 ± 148 for robotic staplers versus USD 1,477 ± 89 for laparoscopic staplers (p < 0.0001). This cost differential underscores a critical consideration for healthcare providers when choosing surgical techniques.
Discussion
The findings of this study are consistent with previous research indicating that while robotic staplers are safe and feasible for use in RYGB, they generally result in longer operative times and increased costs compared to laparoscopic staplers. The higher resource utilization associated with robotic stapling, including more frequent instrument exchanges and additional stapler firings, contributed to this disparity.
Although robotic staplers offer enhanced manoeuvrability, particularly in confined surgical spaces, the current study’s context of RYGB—where access is relatively straightforward—questions the necessity of this added complexity and expense.
Conclusion
In conclusion, the study demonstrated that laparoscopic staplers offer a more efficient and cost-effective alternative to robotic staplers in robot-assisted RYGB without compromising patient safety. While robotic staplers can be safely integrated into surgical practice, their advantages may not justify the increased resource use and costs in this specific context. Further research is warranted to explore the generalizability of these findings across different surgical teams and settings.
READ MORE… https://link.springer.com/article/10.1007/s11701-025-02223-6
