title: Robotic vs. Laparoscopic Sleeve Gastrectomy in Adolescents; Reality or Hype.
abstract: 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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, WB4154, Columbus, OH, 43212, USA. victoria.pepper@nationwidechildrens.org.
authors.forename: Victoria K
authors.initials: VK
authors.lastname: Pepper
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, WB4154, Columbus, OH, 43212, USA.|Department of Surgery, OSU Medical Center, Columbus, OH, USA.
authors.forename: Terrence M
authors.initials: TM
authors.lastname: Rager
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, WB4154, Columbus, OH, 43212, USA.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Diefenbach
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.
authors.forename: Mehul V
authors.initials: MV
authors.lastname: Raval
authors.affiliation: Department of Pediatric Surgery, Levine Children's Hospital, Charlotte, NC, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Teich
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, WB4154, Columbus, OH, 43212, USA.
authors.forename: Marc P
authors.initials: MP
authors.lastname: Michalsky
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D003365:Costs and Cost Analysis; D005260:Female; D005743:Gastrectomy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D014481:United States; D015431:Weight Loss
keywords: Adolescent obesity; Bariatrics; Cost analysis; Robotic sleeve gastrectomy