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Robotic versus laparoscopic stapling during robotic Roux-en-Y gastric bypass surgery: a case-matched analysis of costs and clinical outcomes

Abstract

Background

The purpose of this analysis is to compare the robotic EndoWrist Stapling System (EWSS) 45 mm (Intuitive Surgical Inc. Sunnyvale, CA, USA) and the ECHELON FLEX ENDOPATH® Staplers (EFES) 60 mm (Ethicon, Cincinnati, OH, USA) for gastric pouch formation during robotic gastric bypass surgery.

Methods

Patients who underwent robotic gastric bypass surgery with stapling using EWSS were matched with patients who underwent the same procedure with the EFES. Demographic, intra- and postoperative, and cost data were collected and analyzed.

Results

A total of 49 patients were identified who had undergone robotic gastric bypass surgery using EWSS. They were matched with 49 patients who underwent the equivalent procedure using EFES. With similar demographic parameters, corrected operating room time without cholecystectomy took longer for the patients that underwent surgery with EWSS (+22 min, p = 0.1042). Stapler clamping was unsuccessful in 19.0% of all recorded attempts with EWSS. Two intra-operative complications unrelated to stapling and one complication due to stapling were observed in the EWSS cohort, while none was observed for the EFES group. Significantly, more recharges were needed with EWSS to complete the gastric pouch (4.9 vs. 4.1, p = 0.0048) and overall stapling costs for the procedure were significantly higher (2212.2 vs. 1787.4 USD, p = 0.0001).

Conclusion

Gastric pouch formation using EWSS during robotic gastric bypass surgery is feasible. Due to the shorter length of EWSS compared to EFES, more stapling recharges are required to complete gastric pouch formation and the stapling costs for gastric bypass surgery are higher. Further systematic research should be conducted to precisely determine the value of the robotic EWSS for gastric bypass surgery.

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Acknowledgements

We thank Francoise Bernardi (University Hospital Geneva) for data collection.

Author information

Correspondence to Monika E. Hagen.

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Disclosures

Monika E. Hagen received personal fees and non-financial support from Intuitive Surgical Inc., outside this project. Monika E. Hagen received personal fees from Ethicon Inc., outside this project. Minoa K. Jung received non-financial support from Intuitive Surgical Inc., outside this project. Jassim Fakhro, Nicolas C. Buchs, Leo Buehler, Jona Mendoza, and Philippe Morel have no conflicts of interest or financial ties to disclose.

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Cite this article

Hagen, M.E., Jung, M.K., Fakhro, J. et al. Robotic versus laparoscopic stapling during robotic Roux-en-Y gastric bypass surgery: a case-matched analysis of costs and clinical outcomes. Surg Endosc 32, 472–477 (2018). https://doi.org/10.1007/s00464-017-5707-6

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Keywords

  • Stapling
  • EndoWrist
  • Echelon
  • da Vinci
  • Robotic
  • Robotic surgery
  • Gastric bypass
  • RYGB