Evidence mapPaperPMID 40537685Full record

ArticleSurgical endoscopy2025

Characterizing advanced stapling technique using objective performance indicators in robotic-assisted sleeve gastrectomy: a retrospective cohort study.

Sarah Choksi, Bishaka Hirachan, Mattia Ballo, Jon Winalski, Kavita Jain, Ruben Salas-Parra, Craig Profant, Dimitre Stefanov, Max Berniker, Mitchell S Roslin and 4 more

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Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Sarah ChoksiNorthwell, 2000 Marcus Ave Suite 300, New Hyde Park, NY, 11042, USA. sarah.choksi@outlook.com.ORCID http://orcid.org/0009-0004-2549-7647
Bishaka HirachanNorthwell, 2000 Marcus Ave Suite 300, New Hyde Park, NY, 11042, USA.
Mattia BalloNorthwell, 2000 Marcus Ave Suite 300, New Hyde Park, NY, 11042, USA.
Jon WinalskiNorthwell, 2000 Marcus Ave Suite 300, New Hyde Park, NY, 11042, USA.
Kavita JainNorthwell, 2000 Marcus Ave Suite 300, New Hyde Park, NY, 11042, USA.
Ruben Salas-ParraNorthwell, 2000 Marcus Ave Suite 300, New Hyde Park, NY, 11042, USA.
Craig ProfantNorthwell, 2000 Marcus Ave Suite 300, New Hyde Park, NY, 11042, USA.
Dimitre StefanovNorthwell, 2000 Marcus Ave Suite 300, New Hyde Park, NY, 11042, USA.
Max BernikerData and Analytics, Intuitive Surgical, Inc., 5655 Spalding Dr., Peachtree Corners, GA, 30092, USA.
Mitchell S RoslinNorthwell, 2000 Marcus Ave Suite 300, New Hyde Park, NY, 11042, USA.
Vikrom DharNorthwell, 2000 Marcus Ave Suite 300, New Hyde Park, NY, 11042, USA.
Andrew YeeData and Analytics, Intuitive Surgical, Inc., 5655 Spalding Dr., Peachtree Corners, GA, 30092, USA.
Marc BesslerNorthwell, 2000 Marcus Ave Suite 300, New Hyde Park, NY, 11042, USA.
Filippo FilicoriNorthwell, 2000 Marcus Ave Suite 300, New Hyde Park, NY, 11042, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough multiple studies have described the association between the sleeve shape and clinical outcomes, limited objective metrics exist to characterize the creation of the optimal sleeve shape and staple line formation. This study offers a novel, objective method for deconstructing robotic sleeve gastrectomies utilizing advanced stapler-specific metrics with the goal of improving patient outcomes.

methodsRobotic sleeve gastrectomies were performed using the da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA) at our tertiary referral center. This system and the Intuitive data recorder (IDR) were used to collect procedure-specific data. These data included metrics for technique (pitch and yaw during staple fire) and staple line formation [cartridge height (color), staple fire total duration, and pause for compression]. All patients who underwent robotic sleeve gastrectomy in an operating room with an IDR one of the four board-certified, fellowship trained minimally invasive surgeons were included. Postoperative complications including outflow obstructive complications (leaks and PO intolerance) and bleeding were the primary outcomes analyzed. Univariate and multivariate analysis was used to analyze stapler metrics and postoperative outcomes. This is a retrospective cohort study from November 2020 to April 2023.

resultsOf the 344 patients, 15 had obstructive complications which included postoperative PO intolerance and leaks. Logistic regression demonstrated a ten degree increase in absolute pitch for the first staple fire was associated with an 89% higher risk of obstructive complications (OR = 1.89, 95% CI = 1.33-2.70, p < 0.001). While staple height and pause for compression were not associated with bleeding, there may be associations with leaks while examining the last staple fires.

conclusionThis is one of the first studies associating objective stapler-specific metrics used to characterize stapling technique with clinical outcomes in robotic sleeve gastrectomy. Further evaluation of postoperative complications using objective metrics will help standardize technique and improve clinical outcomes.

Indexed as

GastrectomyObesity, MorbidRobotic Surgical ProceduresSurgical StaplingAdultFemaleHumansMaleMiddle AgedPostoperative ComplicationsRetrospective StudiesTreatment OutcomeAdvanced staplerObjective metricsPostoperative outcomesRobotic-assisted sleeve gastrectomyStaple line formationStapling technique

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.