Konstantinos Kossenas, Riad Kouzeiha, Olga Moutzouri, Filippos Georgopoulos
{"title":"体重指数> ~ 40kg /m2（≥III级肥胖）患者的机器人与腹腔镜袖式胃切除术：一项系统综述和荟萃分析","authors":"Konstantinos Kossenas, Riad Kouzeiha, Olga Moutzouri, Filippos Georgopoulos","doi":"10.1007/s11695-025-07881-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Class III obesity (BMI ≥ 40 kg/m<sup>2</sup>) 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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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, I<sup>2</sup> = 81%, P = 0.63). Operative duration was significantly longer for RSG compared to LSG (MD: 27.47, 95% CI: 26.15 to 28.79, I<sup>2</sup> = 0%, P < 0.00001). Readmission rates showed no significant differences between the two approaches (OR: 1.14, 95% CI: 0.67 to 1.92, I<sup>2</sup> = 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 I<sup>2</sup> = 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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":"2333-2341"},"PeriodicalIF":2.9000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Robotic vs Laparoscopic Sleeve Gastrectomy in Patients with BMI > 40 kg/m<sup>2</sup> (Class ≥ III Obesity): A Systematic Review and Meta-Analysis.\",\"authors\":\"Konstantinos Kossenas, Riad Kouzeiha, Olga Moutzouri, Filippos Georgopoulos\",\"doi\":\"10.1007/s11695-025-07881-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Class III obesity (BMI ≥ 40 kg/m<sup>2</sup>) 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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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, I<sup>2</sup> = 81%, P = 0.63). Operative duration was significantly longer for RSG compared to LSG (MD: 27.47, 95% CI: 26.15 to 28.79, I<sup>2</sup> = 0%, P < 0.00001). Readmission rates showed no significant differences between the two approaches (OR: 1.14, 95% CI: 0.67 to 1.92, I<sup>2</sup> = 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 I<sup>2</sup> = 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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":19460,\"journal\":{\"name\":\"Obesity Surgery\",\"volume\":\" \",\"pages\":\"2333-2341\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Obesity Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11695-025-07881-x\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Obesity Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11695-025-07881-x","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/17 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Robotic vs Laparoscopic Sleeve Gastrectomy in Patients with BMI > 40 kg/m2 (Class ≥ III Obesity): A Systematic Review and Meta-Analysis.
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.
期刊介绍：
Obesity Surgery is the official journal of the International Federation for the Surgery of Obesity and metabolic disorders (IFSO). A journal for bariatric/metabolic surgeons, Obesity Surgery provides an international, interdisciplinary forum for communicating the latest research, surgical and laparoscopic techniques, for treatment of massive obesity and metabolic disorders. Topics covered include original research, clinical reports, current status, guidelines, historical notes, invited commentaries, letters to the editor, medicolegal issues, meeting abstracts, modern surgery/technical innovations, new concepts, reviews, scholarly presentations and opinions.
Obesity Surgery benefits surgeons performing obesity/metabolic surgery, general surgeons and surgical residents, endoscopists, anesthetists, support staff, nurses, dietitians, psychiatrists, psychologists, plastic surgeons, internists including endocrinologists and diabetologists, nutritional scientists, and those dealing with eating disorders.
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