Background

Stapling is an essential step during bariatric surgery that can be done by robotic or hand-held laparoscopic staplers. We compared both stapler types regarding their impact on procedure time and stapler-associated costs.

Methods

We retrospectively analyzed 105 patients who underwent robot-assisted Roux-en-Y gastric bypass (RYGB) surgery with robotic staplers (EndoWrist, Intuitive Surgical) (n=50) or laparoscopic staplers (Signia, Medtronic) (n=55) between May 2022 and November 2023 at a single institute. Primary outcomes were operating room time and stapler-associated costs. Secondary outcomes were console time, active time (when the robot was active instead of waiting), number of instrument exchanges, and length of stay. Outcomes were compared using unpaired t-tests.

Results

Patient populations treated with laparoscopic and robotic staplers were comparable regarding age, weight, Body Mass Index, and simultaneous hiatal hernia repair. Compared to robotic staplers, laparoscopic staplers significantly reduced operating room time by 17.62+-5.48 min (mean difference +- standard error) (p=0.0017), console time by 16.23+-4.97 min (p=0.0015), and active time by 13.88+-4.42 min (p=0.0022). This resulted in 2.35+-1.10 min less waiting time (p=0.0348). In addition, laparoscopic staplers required 65% fewer instrument exchanges (p<0.0001), reduced the number of stapler firings per surgery from 6.70+-0.61 to 6.29+-0.46 (p=0.0002), and saved USD 698+-24 in material costs for stapling (p<0.0001). The length of stay was comparable for both stapler types (p=0.2308). No intra- or post-operative complications were observed in either group.

Conclusions

The use of laparoscopic staplers streamlined robot-assisted RYGB: stapling was more efficient and less costly than with robotic staplers without affecting patient safety.