Robotic vs Laparoscopic Sleeve Gastrectomy in Patients with BMI > 40 kg/m2 (Class ≥ III Obesity): A Systematic Review and Meta-Analysis.

Abstract

Background: Class III obesity (BMI ≥ 40 kg/m²) is a growing global health concern, often managed with bariatric surgery. A major surgical intervention is sleeve gastrectomy, which can be performed either robotically (RSG) or laparoscopically (LSG). However, there is limited data with regards to RSG vs LSG outcomes for patients with Class III obesity or greater.

Methods: We adhered to PRISMA 2020 guidelines and Cochrane handbook. We examined studies that included patients with obesity Class III or greater who had undergone RSG and were compared to LSG. We collected data regarding the peri-operative outcomes and we analysed them using random effects models with mean differences or odds ratios. Sensitivity analysis was performed for outcomes with moderate to high heterogeneity.

Results: A total of seven studies were included in the meta-analysis, with a total of 63,286 patients (5,314 RSG and 57,972 LSG). No significant differences were observed in the length of hospital stay between RSG and LSG (MD: 0.06, 95% CI: -0.19 to 0.31, I² = 81%, P = 0.63). Operative duration was significantly longer for RSG compared to LSG (MD: 27.47, 95% CI: 26.15 to 28.79, I² = 0%, P < 0.00001). Readmission rates showed no significant differences between the two approaches (OR: 1.14, 95% CI: 0.67 to 1.92, I² = 41%, P = 0.64). Conversion rates, surgical site infections, and bleeding events also had no significant differences between RSG and LSG (conversion OR: 0.48, 95% CI: 0.15 to 1.61; SSI OR: 0.32, 95% CI: 0.06 to 1.68; bleeding OR: 0.86, 95% CI: 0.55 to 1.34; all with I² = 0%). Sensitivity analysis revealed no significant impact of individual studies on the pooled estimates, except for a decrease in heterogeneity for readmission rates after excluding one study.

Conclusion: With the available limited evidence, robotic sleeve gastrectomy does not convey any substantial benefits over the conventional laparoscopic approach. However, due to the limited number of studies identified as well as the small number of studies retained for some outcomes, caution is needed when interpreting the results. Future research is required to examined the estimated weight loss and draw definitive conclusions.