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                           Sleeve Gastrectomy for Morbid Obesity: Robotic vs Standard Laparoscopic Sleeve Gastrectomy Methods
          exclusion Criteria                                  141.4 to 85.8 kg for RSG patients. Likewise, the mean
                                                              preoperative BMI reduced from 83.8 to 30.3 among SLSG
          Patients with bMI ≥40 kg/m². Operative technique used   patients and 51 to 30.5 at 1 year for RSG patients.
          was similar: gastrolysis is performed from 5 cm proximal      The mean quality of life for SLSG rose from a preope-
          to the pylorus up to the angle of His. Approximately, 100 to   rative value of 2.3 to 8.3 after surgery, and from a value of
                                              21
          150 ml of sleeve is created over size 38 Fr  bougie using   2.3 to a postoperative value of 8.45 for RSG.
          Echelon Flex linear stapler with  60 mm. The staple line      In this series, 14 out of 20 SLSG patients (70%) and 11
          is imbricated with PDS (polydioxanone) 2-0 continuous   out of 20 RSG (55%) patients had obstructive sleep apnea.
          sutures and peroperative endoscopy is done.         The resolution of obstructive sleep apnea was dramatic with
             The measures of outcome studied were: duration of    a value of 78.6% observed within the first 1 month and 100%
          surgery, cost of operation, duration of hospital stay, percen-  in 3 months for patients operated by SLSG. 81.8% in 1 month
          tage of excess weight loss (%EWL)/bMI, quality of life,   100% in 3 months were observed for RSG patients. Eleven
          comorbidity resolution and complications.
                                                              out of the 20 (SLSG 55%) and seven out of 20 (RSG 35%)
                                                              had diabetes mellitus. There was a noticeable improvement
          ReSuLTS
                                                              in diabetic status as seen in the reduction in the percentage of
          The duration of surgery for SLSG was found to vary from   patients on insulin from 81.9% in the first month to 18.1% at
          121 to 150 minutes with a mean of 142.7 minutes, while the  1 year for SLSG patients, i.e. 81.9% being off their insulin
          overall operative time for RSG was between 132 and 188  at 1 year. A similar drop was noticed for RSG patients from
          minutes with an average of 150.4 minutes (Table 1). The  71.4 to 28.6% respectively, with 71.4% of diabetics going
          mean docking time was 17.9 minutes.                 off their insulin at 1 year.
             The cost of surgery for SLSG was found to be 7500 USD     Sixty percent (12 out of 20) of SLSG patients and 70%
          while that of RSG was 9000 USD (Table 1 and Graph 1). The  (14 out of 20) of patients operated by RSG were hyperten-
          duration of hospital stay for SLSG varied from 3 to 11 days  sive. From this value, there was a reduction in the number of

          with a mean value of 4.6 days, while for RSG it span from 3 to  patient taking antihypertensive agents to control their blood
          6 days with a mean value of 3.9 days.               pressure from 100% in the first month to 41.7% (58.3% being
             The mean percentage excess weight loss for SLSG at  off their drugs) at 1 year for SLSG patients and from 100
          1 year was 83.8 and 82.0% for RSG (Table 2). The mean  to 35.7% (64.3% off drugs) respectively for RSG patients.
          preoperative BMI for SLSG and RSG were 53.1 and 51.0  Three patients (15%) were observed to have some significant
          respectively (Tables 2 and 3). In this series, the progression  complications among the SLSG group as against one patient
          of mean percentage excess weight loss by month for SLSG  (5%) in the RSG group.
          was 23.4% → 45.1% → 58.9% → 83.9%, and 23.7% →
          40.8% → 60.8% → 82.8% for RSG at 1, 3, 6 months and   dISCuSSIOn
          1 year. In this study, the mean preoperative body weight  Duration of surgery, cost of operation, duration of hospi-
          reduced from 139.2 to 79.6 kg at 1 year for SLSG and from  tal stay, %EWL/bMI, QoL, comorbidity resolution and

                                        Table 1: Summary of parameters for SLSG and RSG
           Parameters                              SLSG                                   RSG
                                   Mean value c 2     p-value  Conclusion Mean value c 2     p-value  Conclusion
           Mean operative time     142.7     17.4     30.144   p > c 2   150.4     17.003    30.144   p > c 2
           Mean hospital stay      4.6       14.81    30.144   p > c 2   3.9       3.59      30.144   p > c 2
           Mean postop QOL         8.3       0.899    30.144   p >> c 2  8.45      0.576     30.144   p >> c 2
           Mean %EWL at 1 year     83.8      45.11    30.144   p < c 2   82        82        30.144   p < c 2
           Mean preop body weight  139.2     138.36   30.144   p < c 2   141.4     146.60    30.144   p < c 2
           Mean percentage of change in
           BMI at 1 year           41.5      15.309   30.144   p > c 2   40.1      4.323     30.144   p > c 2
           Resolution of hypertension at            58.3                                  64.3
           1 year (%)
           Resolution of diabetes mellitus          81.9                                  71.4
           at 1 year (%)
           Percentage of complications               15                                    5
           Mean cost of surgery                    $7500                                 $9000
           Resolution of obstructive sleep          100                                   100
           apnea at 1 year (%)
                                                                          2
                                               2
           Note: Data is highly reproducible, if p-value >> c ; Data is reproducible, if p-value > c ; Data is nonreproducible, if p-value < c 2
          World Journal of Laparoscopic Surgery, January-April 2014;7(1):1-6                                  3
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