Robotic-assisted sleeve gastrectomy: an analysis of cost, peri-operative outcomes and learning curve in a prospective cohort study.

Minimally invasive sleeve gastrectomy as a treatment for individuals living with severe obesity remains the most common operation in bariatric and metabolic surgery. With the introduction of robotic-assisted surgery, an increasing proportion of sleeve gastrectomies are performed using the da Vinci robotic surgical platform. To date, the evidence to support or contest this practice is still unclear although meta-analyses have shown safety and feasibility. Here we present a prospective cohort study comparing 101 consecutive patients who had either robotic-assisted or laparoscopic sleeve gastrectomy for obesity. Short-term outcomes, including length of stay and thirty-day complication rates, as well as the total consumable cost for both the laparoscopic and robotic-assisted procedures were collected. We also assessed the learning curve associated with robotic-assisted sleeve gastrectomy. The cohort had similar baseline characteristics in terms of BMI and co-morbidity. The mean operative time, post-operative CRP and complication rates were the same in both groups. Length of stay was statistically shorter for the robotic-assisted cohort in comparison to the laparoscopic cohort; 1.3 days versus 1.9 days, respectively (p < 0.005). The percentage of patients requiring only a single night admission was significantly higher at 82% in the robotic-assisted group, compared to 32% in the laparoscopic group (p < 0.005); in the context of a nurse-led-discharge protocol. Total consumable cost was significantly lower in the robotic group at an average of £2310, compared to £2665 in the laparoscopic group (p < 0.001). The learning curve for the procedure was found to be 26 cases, predominantly driven by the resectional component of the procedure. Robotic-assisted sleeve gastrectomy on the 4th generation da Vinci system utilising robotic advanced energy and Sureform stapling is safe and effective. This cohort study suggests that using the robotic platform is favourable in terms of overall consumable cost and may reduce length of stay. In the context of previous robotic experience, the observed learning curve is relatively short.