Robotic approach is slowly rising in metabolic surgery, and laparoscopy is still considered the gold standard for Sleeve Gastrectomy. Aim of our study was to assess and compare outcomes of RSG through a matched comparison with LSG. Retrospective search of prospectively maintained database of our surgical department was carried out find all consecutive patients who underwent RSG from April 2023 to August 2024. Each subject who underwent RSG was matched one-to-one with a patient treated with LSG in the same period. Operative time (docking + console time for the robotic procedures), length of stay, need for rescue drugs, and perioperative complications were recorded calculated and compared. A total number of 50 patients (25 RSG and 25 LSG) were included in the present analysis. Operative time in the LSG group was significantly shorter than in the RSG group (57.8 ± 12.3 VS 80.6 ± 16.6 min, p < 0.01), but it was comparable to console time (57.8 ± 12.3 VS 56.9 ± 19.6, p = 0.85). Mean docking time was 23.7 ± 11 min. Length of stay, readmissions, conversion to laparoscopy/open surgery, early complications, and rescue drugs administration were comparable between the two groups. Age, sex, and BMI were not good predictors neither of laparoscopic nor robotic operative time. RSG during the learning curve proved as safe as LSG, but it was associated with longer operative time due to the duration of the docking step. Operation length may become comparable once the learning curve plateau is reached. Age, BMI, and sex are not good criteria of choice between the two approaches.

Background: Robotic sleeve gastrectomy (RSG) is gaining adoption in metabolic bariatric surgery, yet evidence on its perioperative safety, efficiency, and costs during the early learning phase remains limited. Objectives: To evaluate outcomes, learning curve dynamics, and procedural costs for totally robotic sleeve gastrectomy. Setting: Academic center. Methods: A retrospective analysis was conducted of the first 53 consecutive RSGs (April 2023–July 2025) performed by a single surgeon using a standardized fully robotic technique. Perioperative variables, 30-day morbidity, and cost data were collected. Learning curves for docking time, console time, and total operative time were assessed using Cumulative Sum (CUSUM) analysis. Results: Mean age and BMI were 38.1 ± 12.6 years and 41.6 ± 6.3 kg/m ² , respectively; 71.7% were female. Overall complication rate was 7.5% (3 bleedings, 1 leak) with no mortality or reinterventions. ICU admission and readmission each occurred in 1.9% of cases. Mean docking time was 17.8 ± 9.4 min, console time 51.5 ± 17.0 min, and total operative time 69.3 ± 18.1 min. The mean length of stay was 3.6 ± 1.1 days (range 2–10). CUSUM identified proficiency points at case 18 for docking time (− 51.1%), case 23 for console time (− 18.6%), and case 22 for total operative time (− 21.5%). Median length of stay was 3 days. Mean direct instrument/stapling cost per RSG was €4,535. Conclusions: Totally RSG can be introduced with safe outcomes even during the learning phase. Proficiency for operative efficiency was reached after 20 cases. Graphical

Injury to the Luschka ducts (LDs), also named “subvesicular” ducts, is an under-reported cause of biliary leak following laparoscopic cholecystectomy (LC). A systematic literature search according to PRISMA guidelines was conducted in PubMed, EMBASE and Cochrane Library including all publications that described a bile leak from an LD. A total of 136 articles were retrieved from the searched databases. After the removal of duplicates and non-eligible papers, 48 studies reporting 231 leaks were included: 20 (41.6%) case reports, 2 (4.3%) comparative studies, 7 (14.9%) meeting abstracts and 19 (40.4%) retrospective cohort articles. The rate of LD leak ranges from 0.05% to 1.9%, but injury to a duct of Luschka was the second most common cause of biliary leakage in all the cohort studies (5.5% to 41%). In 21 (43.7%) cases, the leak was successfully treated with a sphincterotomy through Endoscopic Retrograde Cholangiopancreatography (ERCP) plus or minus stenting, and in 12 (25%), re-laparoscopy was necessary.

Background: Hypoparathyroidism-related hypocalcemia is a common complication after total thyroidectomy (TT), particularly if there is a history of prior bariatric surgery. However, it is still unknown if it is the surgery timing or the type of bariatric intervention that increases the risk of developing this complication. Methods: We compared the risk of hypocalcemia (serum calcium levels < 8 mg/dL) and hypoparathyroidism (both transient and permanent) between patients with restrictive procedures (LSG and GB) and patients without a history of obesity surgery in the immediate post-operative period and after 12 months. Hypoparathyroidism was considered permanent if the plasma parathyroid hormone (PTH) levels at 6 months were less than 15 pg/mL and the patient still required oral calcium (calcium carbonate) and vitamin D supplementation, in addition to the supplements that were taken routinely before thyroidectomy. Results: From the 96 patients who underwent TT, 50% had a history of bariatric surgery: 36 LSG and 12 GB. The risk of hypocalcemia was similar in patients with a history of restrictive procedures (31.35%) and in controls (25%) (p = 0.49). Furthermore, hypocalcemia risk was similar between patients with a history of LSG (30.5%) and GB (33%) (p = 0.85). The prevalences of transient and permanent hypoparathyroidism were similar between patients with a history of restrictive procedures and in controls; similarly, no differences were detected between subjects undergoing LSG and GB. Conclusions: Restrictive bariatric surgery (LSG and GB) is not a risk factor for post-thyroidectomy hypocalcemia and hypoparathyroidism and thus did not require a different perioperative supplementation protocol compared to subjects without history of bariatric surgery undergoing TT.