Skip to main content

Advertisement

Log in

Robotic vs. Laparoscopic Sleeve Gastrectomy in Adolescents; Reality or Hype

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

The rising prevalence of childhood obesity and concomitant increase in comorbid disease pose significant challenges for the health care system. While mounting evidence demonstrates the safety and efficacy of bariatric surgery for severely obese adolescents, the potential role of robotic technology has not been well defined.

Objective

The aim of this study was to establish the safety and efficacy of robotic-assisted laparoscopic sleeve gastrectomy (RSG) in treating severe adolescent obesity. In addition, 30-day outcomes and hospital charges were compared to subjects undergoing RSG versus laparoscopic sleeve gastrectomy (LSG).

Methods

A retrospective analysis of 28 subjects (14 LSG vs. 14 RSG) at a single institution was conducted. Data collection included demographics, body mass index, comorbidities, hospital length of stay (LOS), operative time, 30-day outcomes, and hospital charges. Analysis was performed using chi-square, Fisher’s exact, and nonparametric Wilcoxon rank sum tests.

Results

There were no differences in subject demographics or comorbidities. While median operative time was longer for RSG vs. LSG (132 vs. 100 min, p = 0.0002), the median LOS for RSG compared to LSG was shorter (69.6 vs. 75.9 h, p = 0.0094). In addition, RSG-related hospital charges were higher ($56,646 vs. $49,498, p = 0.0366). No significant differences in post-operative outcomes or complications were observed.

Conclusions

RSG is equally safe and efficacious when compared to LSG among adolescents. Similar to studies in adults, LOS is shortened while hospital charges are higher. Larger prospective studies are needed to gain insight regarding cost benefit ratios.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Population-based prevention strategies for childhood obesity: report of a WHO forum and technical meeting. In: Morgan A, editor. Geneva: WHO Forum and Technical Meeting; 2009. p. 40.

  2. Ogden CL, Carroll MD, Kit BK, et al. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA J Am Med Assoc. 2014;311(8):806–14. doi:10.1001/jama.2014.732.

    Article  CAS  Google Scholar 

  3. Inge TH, Zeller MH, Jenkins TM, et al. Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. JAMA Pediatr. 2014;168(1):47–53. doi:10.1001/jamapediatrics.2013.4296.

    Article  PubMed  PubMed Central  Google Scholar 

  4. de Onis M, Blossner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr. 2010;92(5):1257–64. doi:10.3945/ajcn.2010.29786.

    Article  PubMed  Google Scholar 

  5. Singh AS, Mulder C, Twisk JW, et al. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev Off J Int Assoc Study Obes. 2008;9(5):474–88. doi:10.1111/j.1467-789X.2008.00475.x.

    Article  CAS  Google Scholar 

  6. Caprio S, Daniels SR, Drewnowski A, et al. Influence of race, ethnicity, and culture on childhood obesity: implications for prevention and treatment: a consensus statement of shaping America’s health and the obesity society. Diabetes Care. 2008;31(11):2211–21. doi:10.2337/dc08-9024.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Choudhary AK, Donnelly LF, Racadio JM, et al. Diseases associated with childhood obesity. AJR Am J Roentgenol. 2007;188(4):1118–30. doi:10.2214/AJR.06.0651.

    Article  PubMed  Google Scholar 

  8. Treadwell JR, Sun F, Schoelles K. Systematic review and meta-analysis of bariatric surgery for pediatric obesity. Ann Surg. 2008;248(5):763–76. doi:10.1097/Sla.0b013e31818702f4.

    Article  PubMed  Google Scholar 

  9. Jen HC, Rickard DG, Shew SB, et al. Trends and outcomes of adolescent bariatric surgery in California, 2005–2007. Pediatrics. 2010;126(4):e746–53. doi:10.1542/peds.2010-0412.

    Article  PubMed  Google Scholar 

  10. Kelleher DC, Merrill CT, Cottrell LT, et al. Recent national trends in the use of adolescent inpatient bariatric surgery: 2000 through 2009. JAMA Pediatr. 2013;167(2):126–32. doi:10.1001/2013.jamapediatrics.286.

    Article  PubMed  Google Scholar 

  11. O’Brien PE, Sawyer SM, Laurie C, et al. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. JAMA J Am Med Assoc. 2010;303(6):519–26. doi:10.1001/jama.2010.81.

    Article  Google Scholar 

  12. Chandra V, Dutta S, Albanese CT. Surgical robotics and image guided therapy in pediatric surgery: emerging and converging minimal access technologies. Semin Pediatr Surg. 2006;15(4):267–75. doi:10.1053/j.sempedsurg.2006.07.006.

    Article  PubMed  Google Scholar 

  13. Zeller M, Kirk S, Claytor R, et al. Predictors of attrition from a pediatric weight management program. J Pediatr. 2004;144(4):466–70. doi:10.1016/j.jpeds.2003.12.031.

    Article  PubMed  Google Scholar 

  14. Levine MD, Ringham RM, Kalarchian MA, et al. Is family-based behavioral weight control appropriate for severe pediatric obesity? Int J Eat Disord. 2001;30(3):318–28.

    Article  CAS  PubMed  Google Scholar 

  15. Messiah SE, Lopez-Mitnik G, Winegar D, et al. Changes in weight and co-morbidities among adolescents undergoing bariatric surgery: 1-year results from the bariatric outcomes longitudinal database. Surg Obes Relat Dis Off J Am Soc Bariatric Surg. 2013;9(4):503–13. doi:10.1016/j.soard.2012.03.007.

    Article  Google Scholar 

  16. Teeple EA, Teich S, Schuster DP, et al. Early metabolic improvement following bariatric surgery in morbidly obese adolescents. Pediatr Blood Cancer. 2012;58(1):112–6. doi:10.1002/pbc.23370.

    Article  CAS  PubMed  Google Scholar 

  17. Michalsky MP, Raman SV, Teich S, et al. Cardiovascular recovery following bariatric surgery in extremely obese adolescents: preliminary results using cardiac magnetic resonance (CMR) imaging. J Pediatr Surg. 2013;48(1):170–7. doi:10.1016/j.jpedsurg.2012.10.032.

    Article  PubMed  Google Scholar 

  18. Xanthakos SA. Bariatric surgery for extreme adolescent obesity: indications, outcomes, and physiologic effects on the gut-brain axis. Pathophysiol Off J Int Soc Pathophysiol ISP. 2008;15(2):135–46. doi:10.1016/j.pathophys.2008.04.005.

    Google Scholar 

  19. Bondada S, Jen HC, Deugarte DA. Outcomes of bariatric surgery in adolescents. Curr Opin Pediatr. 2011;23(5):552–6. doi:10.1097/MOP.0b013e32834a1b49.

    Article  PubMed  Google Scholar 

  20. Nguyen NT, Nguyen B, Gebhart A, et al. Changes in the makeup of bariatric surgery: a national increase in use of laparoscopic sleeve gastrectomy. J Am Coll Surg. 2013;216(2):252–7. doi:10.1016/j.jamcollsurg.2012.10.003.

    Article  PubMed  Google Scholar 

  21. Till H, Bluher S, Hirsch W, et al. Efficacy of laparoscopic sleeve gastrectomy (LSG) as a stand-alone technique for children with morbid obesity. Obes Surg. 2008;18(8):1047–9. doi:10.1007/s11695-008-9543-6.

    Article  CAS  PubMed  Google Scholar 

  22. Nadler EP, Barefoot LC, Qureshi FG. Early results after laparoscopic sleeve gastrectomy in adolescents with morbid obesity. Surgery. 2012;152(2):212–7. doi:10.1016/j.surg.2012.05.010.

    Article  PubMed  Google Scholar 

  23. Bruns NE, Soldes OS, Ponsky TA. Robotic surgery may not “make the cut” in pediatrics. Front Pediatr. 2015;3:10. doi:10.3389/fped.2015.00010.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Griffen FD, Sugar JG. The future of robotics: a dilemma for general surgeons. Bull Am Coll Surg. 2013;98(7):9–15.

    PubMed  Google Scholar 

  25. Vilallonga R, Fort JM, Gonzalez O, et al. The initial learning curve for robot-assisted sleeve gastrectomy: a surgeon’s experience while introducing the robotic technology in a bariatric surgery department. Minim Invasive Surg. 2012;2012:347131. doi:10.1155/2012/347131.

    PubMed  PubMed Central  Google Scholar 

  26. Pratt JS, Lenders CM, Dionne EA, et al. Best practice updates for pediatric/adolescent weight loss surgery. Obesity (Silver Spring). 2009;17(5):901–10. doi:10.1038/oby.2008.577.

    Article  Google Scholar 

  27. Schauer PR, Schirmer BD, Brethauer SA. Minimally invasive bariatric surgery. New York: Springer; 2007. xxii, 523 p. p.

    Book  Google Scholar 

  28. Salman M, Bell T, Martin J, et al. Use, cost, complications, and mortality of robotic versus nonrobotic general surgery procedures based on a nationwide database. Am Surg. 2013;79(6):553–60.

    PubMed  Google Scholar 

  29. Moses G, Seagull FJ, Sutton E, et al. The University of Maryland, Maryland Advanced Simulation, Training, Research and Innovation (MASTRI) Center. J Surg Educ. 2010;67(6):473–6. doi:10.1016/j.jsurg.2010.05.012.

    Article  PubMed  Google Scholar 

  30. Zihni AM, Ohu I, Cavallo JA, et al. Ergonomic analysis of robot-assisted and traditional laparoscopic procedures. Surg Endosc. 2014. doi:10.1007/s00464-014-3604-9.

    PubMed Central  Google Scholar 

  31. Schmitz AK, Vierhaus M, Lohaus A. Pain tolerance in children and adolescents: sex differences and psychosocial influences on pain threshold and endurance. Eur J Pain. 2013;17(1):124–31. doi:10.1002/j.1532-2149.2012.00169.x.

    Article  PubMed  Google Scholar 

  32. Barnett SJ. Bariatric surgical management of adolescents with morbid obesity. Curr Opin Pediatr. 2013;25(4):515–20. doi:10.1097/MOP.0b013e328362cd96.

    Article  PubMed  Google Scholar 

  33. Fourman MM, Saber AA. Robotic bariatric surgery: a systematic review. Surge Obes Relat Dis Off J Am Soc Bariatr Surg. 2012;8(4):483–8. doi:10.1016/j.soard.2012.02.012.

    Article  Google Scholar 

  34. Vilallonga R, Fort JM, Caubet E, et al. Robotic sleeve gastrectomy versus laparoscopic sleeve gastrectomy: a comparative study with 200 patients. Obes Surg. 2013;23(10):1501–7. doi:10.1007/s11695-013-1039-3.

    Article  PubMed  Google Scholar 

  35. Schraibman V, Macedo AL, Epstein MG, et al. Comparison of the morbidity, weight loss, and relative costs between robotic and laparoscopic sleeve gastrectomy for the treatment of obesity in Brazil. Obes Surg. 2014. doi:10.1007/s11695-014-1239-5.

    PubMed  Google Scholar 

  36. Wilson EB, Sudan R. The evolution of robotic bariatric surgery. World J Surg. 2013;37(12):2756–60. doi:10.1007/s00268-013-2125-3.

    Article  PubMed  Google Scholar 

  37. Romero RJ, Kosanovic R, Rabaza JR, et al. Robotic sleeve gastrectomy: experience of 134 cases and comparison with a systematic review of the laparoscopic approach. Obes Surg. 2013;23(11):1743–52. doi:10.1007/s11695-013-1004-1.

    Article  PubMed  Google Scholar 

  38. Garness RL, Zarroug AE, Kumar S, et al. Laparoscopic sleeve gastrectomy in a pediatric patient. Surg laparosc Endosc Percutaneous Tech. 2012;22(2):e112–4. doi:10.1097/SLE.0b013e318247c1b0.

    Article  Google Scholar 

  39. Mottrie A, Novara G. Is surgery a never-ending learning process? BJU Int. 2014;114(4):472–3. doi:10.1111/bju.12694.

    Article  PubMed  Google Scholar 

  40. Toro JP, Lin E, Patel AD. Review of robotics in foregut and bariatric surgery. Surg Endosc. 2015;29(1):1–8. doi:10.1007/s00464-014-3646-z.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Wei Wang, MS, Jennifer Cooper, MS, Lindsey Asti, MS, Jennifer Smith, RN, Anita, Joselyn, MD, and Tarun Bhalla, MS for their aiding this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Victoria K. Pepper.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent was not required.

Conflict of Interest

The authors declare they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pepper, V.K., Rager, T.M., Diefenbach, K.A. et al. Robotic vs. Laparoscopic Sleeve Gastrectomy in Adolescents; Reality or Hype. OBES SURG 26, 1912–1917 (2016). https://doi.org/10.1007/s11695-015-2029-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-015-2029-4

Keywords

Navigation