- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05224791
A Retrospective Multicenter Comparison of Laparoscopic and Robotic-Assisted Roux-en-Y Gastrectomy
A Retrospective Multicenter Comparison of Laparoscopic and Robotic-Assisted Roux-en-Y Gastric Bypass and Sleeve Gastrectomy
Study Overview
Status
Intervention / Treatment
Detailed Description
Procedure Description 1.2.1 Roux-en-Y Gastric Bypass The RYGB connects a limb of the intestine to a much smaller stomach pouch, which prevents the bile from entering the upper part of the stomach and esophagus, thereby effectively bypassing the remaining stomach and first segment of the small intestine. 21 The first step of RYGB involves the creation of the gastric pouch. The angle of His is identified with the fundus retracted laterally. The peritoneum, over the angle of His, is dissected with ultrasonic shears or scissors and carried posterior to identify the path for a linear stapler and the left crus of the diaphragm. Next, the mesentery to the lesser curve of the stomach is divided by a stapler. Once the retrogastric plane in the lesser curve is created, two serial applications of stapler will be used to create a 20 mL gastric pouch. 21 The second step is the creation of jejunojejunostomy. A stapler is utilized to create the anastomosis. The common enterotomy is closed with either a single running layer of 2-0 Vicryl or a second firing stapler. Finally, the gastrojejunal anastomosis is created and the Roux limb is pulled up to the level of the gastric pouch. 21
1.2.2 Sleeve Gastrectomy The SG is a restrictive procedure in which a partial left gastrectomy of the fundus and body of the stomach is performed in order to create a long tubular "sleeve" along the lesser curvature. The weight loss and resolution of comorbidities are attributed not only to the restrictive nature of the procedure but also to restriction by the pylorus, decreased ghrelin, increased satiety, increased gastric emptying, and faster small bowel transit times with a component of malabsorption.17-20
1.2 Aim(s)/Objective(s) The overall aim of this study is to evaluate and compare outcomes associated with robotic-assisted and laparoscopic bariatric surgery.
1.3 Rationale for the Study Studies to date have drawn partial contrasting conclusions when comparing robotic-assisted and laparoscopic bariatric surgery. There is a need to collect more scientific evidence data around the clinical outcomes of bariatric surgery performed with either robotic-assisted or laparoscopic surgery to describe the potential advantages of these techniques.
1.4 Hypothesis 1.4.1 Primary Hypothesis We hypothesize that the RYGB will indicate better outcomes compared to the SG.
2. OBJECTIVES AND STUDY OUTCOME MEASURES 2.1. Study Objectives The primary objective of this study is to retrospectively compare perioperative outcomes through discharge and short-term outcomes through 30 days after robotic-assisted and laparoscopic bariatric surgery.
2.2. Study Outcome Measures Baseline patient characteristics, intraoperative, post-operative, and short-term clinical data will be obtained from hospital records for a total of up to approximately 400 robotic-assisted and laparoscopic cases among the four subgroups: robotic-assisted RYGB, robotic-assisted SG, laparoscopic RYGB, and laparoscopic SG.
3. STUDY DESIGN This is a multi-center, retrospective chart review study of all consecutive cases of RYGB and SG, performed by participating surgeons at their respective institutions that meet the study inclusion and exclusion criteria.
The chart review will be performed in a reverse chronological order starting at a minimum of 30 days prior to IRB approval of the study at the site until and going back to 2017 (i.e. most current cases in 2020 and chronologically going back through 2017). Study initiation at the participating site will occur once a research agreement has been executed between Intuitive Surgical and the participating institution/ investigator and after IRB approval has been obtained.
It is anticipated that the retrospective chart review will span the period between January 1, 2017 through 30 days prior to IRB approval of the study at each institution. Perioperative and short-term clinical data will be obtained from institutional records. Each participating site and the participating surgeons at those institutions will contribute approximately a minimum of 10 to a maximum of 50 cases to a subgroup. The chart review and data collection will be performed in a reverse chronological order starting at 30 days prior to IRB approval of the study at the institution to 2017.
All the data variables will be documented in the case report forms. This section will provide an overview of the data collected which will include, but are not limited to, the following:
- Pre-Operative Information: Demographics (e.g. age, gender), patient characteristics (e.g. BMI, ASA Class), and pre-operative medical history (e.g. tobacco use, previous abdominal surgery, comorbidities: hypertension, cardiopulmonary disease, diabetes)
- Intra-Operative Data: Operative time, total OR time, bariatric procedure (robotic-assisted RYGB or SG and Laparoscopic RYGB or SG), concomitant procedures, transfusions, conversions, intraoperative adverse events
- Post-Operative Data (up to discharge): Post-operative adverse events, discharge status, hospital length of stay, information on enhanced recovery program
- Short-Term Follow-Up Data (up to 30 days post-discharge): Adverse events up to 30 days, re- admissions, re-operations related to the index procedure Please refer to the case report forms for complete details of data to be collected. Information regarding adverse events will be collected through this study; a list of applicable adverse events can be found below.
Because the data will have been de-identified and is archival in nature, there will be no active subject recruitment and no patient consenting is required. A study specific Informed Consent Waiver for retrospective data collection will be obtained for this study, as required by the institution's IRB policy.
The study duration is anticipated to be approximately 18 months.
- The site activation consisting of IRB submission/approvals, contract execution, and training is anticipated to be completed in approximately 3 to 4 months
- Chart review, data collection, and entry are anticipated to be completed in approximately 6 to 8 months
- Data review is anticipated to be completed in approximately 2 months
- Data analysis is anticipated to be completed in approximately 4 months Study Training All investigators/ site personnel will be trained on the study protocol at a Site initiation visit or at another appropriate training session. Site initiation visit will be scheduled only upon receiving a fully executed data collection agreement and IRB approval. Training of investigators and site study personnel will include, but are not limited to, the investigational plan, protocol requirements, CRF completion, EDC training, recording of adverse events, and study personnel responsibilities related to study compliance and conduct.
Adverse Events Adverse event data will be collected only for those associated with the primary bariatric procedures (RYGB and SG procedures) requiring intervention.
The investigator will be responsible for reviewing all the adverse event case report forms. A detailed list of adverse events is provided in the case report forms. Some examples of commonly anticipated intraoperative and post-operative adverse events are provided below but reported adverse events are not limited to the following.
Examples of intraoperative adverse events
- Bleeding requiring an intervention
- Visceral injury including but not limited to injury to liver, injury to diaphragm, injury to spleen
- Vascular injury including major vascular injury requiring intervention
- Adverse events related to anesthesia (prolonged intubation defined as continued intubation in the recovery room or ICU/step down unit after surgery,)
- Nerve injuries due to patient positioning
- Other intraoperative injuries
Examples of postoperative adverse events
- Postoperative bleeding requiring transfusion or reoperation or another procedure
- Bowel obstruction
- Anastomotic leak
- Anastomotic stricture/ stenosis
- Clostridium difficile infection
- Liver failure
- Pancreatitis
- Peritonitis
- Acid reflux
- Stomach or intestine ulceration
- Wound adverse events: Surgical site Infection-superficial/deep (incisional dehiscence)
- Deep Venous Thrombosis (DVT)
- Genitourinary adverse events (Urinary Tract Infection (UTI) requiring antibiotics)
- Cardiac Adverse events (Atrial arrhythmia requiring treatment, Ventricular arrhythmia requiring treatment, cardiac arrest with CPR, MI)
- New onset renal failure (per the RIFLE criteria)
- Sepsis requiring antibiotics
- Other adverse events: includes any cardiac, pulmonary, gastrointestinal, genitourinary, and neurological adverse events outside of those already listed above
Pre-existing conditions are not reportable as adverse events unless the condition worsens or continues after the procedure. Any events inherent to the procedure are not reportable as adverse events unless the condition worsens or continues after the procedure beyond the expected time frame. Some examples of non-reportable adverse events are listed below:
- Anesthesia related nausea/vomiting occurring <24hrs after surgery
- Leukocytosis as a result of normal post-operative stress response occurring <72hrs after surgery
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Contact
- Name: Colette Ngo Ndjom
- Phone Number: 214-947-4681
- Email: ClinicalResearch@mhd.com
Study Contact Backup
- Name: Ashley Haider
- Phone Number: 2149474459
- Email: ClinicalResearch@mhd.com
Study Locations
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-
Texas
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Dallas, Texas, United States, 75203
- Recruiting
- Minimally Invasive Surgical Associates, Methodist Dallas Medical Center
-
Contact:
- Christina Nwoko
- Phone Number: 214-933-6603
- Email: ChristinaNwoko@mhd.com
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Principal Investigator:
- Sachin S Kukreja, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Sampling Method
Study Population
This is a multi-center, retrospective chart review study of all consecutive cases of RYGB and SG, performed by participating surgeons at their respective institutions that meet the study inclusion and exclusion criteria.
The chart review will be performed in a reverse chronological order starting at a minimum of 30 days prior to IRB approval of the study at the site until and going back to 2017 (i.e. most current cases in 2020 and chronologically going back through 2017). Study initiation at the participating site will occur once a research agreement has been executed between Intuitive Surgical and the participating institution/ investigator and after IRB approval has been obtained.
Description
Inclusion Criteria:
- Subject was 18 years or older at the time of procedure
- Subject who has undergone either laparoscopic or robotic-assisted RYGB or SG between the time frame of 30 days prior to institution's IRB approval date and the year 2017
Subject has one of the below qualifications:
- Body mass index (BMI) > 40 kg/m2 or more than 100 pounds overweight OR
- BMI > 35 kg/m2 and one of the following obesity-related co-morbidities such as type II diabetes mellitus, hypertension, sleep apnea and other respiratory disorders, non- alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.
Exclusion Criteria:
- Subject who underwent RYGB or SG as an emergent procedure
- Subject who underwent RYGB or SG as revisional bariatric procedure
- Subject who underwent RYGB or SG as a secondary (concomitant) procedure and not as a primary procedure
Study Plan
How is the study designed?
Design Details
- Observational Models: Cohort
- Time Perspectives: Retrospective
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Gastric Bypass
The RYGB connects a limb of the intestine to a much smaller stomach pouch, which prevents the bile from entering the upper part of the stomach and esophagus, thereby effectively bypassing the remaining stomach and first segment of the small intestine.
|
The RYGB connects a limb of the intestine to a much smaller stomach pouch, which prevents the bile from entering the upper part of the stomach and esophagus, thereby effectively bypassing the remaining stomach and first segment of the small intestine.
Other Names:
The SG is a restrictive procedure in which a partial left gastrectomy of the fundus and body of the stomach is performed in order to create a long tubular "sleeve" along the lesser curvature.
The weight loss and resolution of comorbidities are attributed not only to the restrictive nature of the procedure but also to restriction by the pylorus, decreased ghrelin, increased satiety, increased gastric emptying, and faster small bowel transit times with a component of malabsorption
Other Names:
|
Sleeve Gastrectomy
The SG is a restrictive procedure in which a partial left gastrectomy of the fundus and body of the stomach is performed in order to create a long tubular "sleeve" along the lesser curvature.
The weight loss and resolution of comorbidities are attributed not only to the restrictive nature of the procedure but also to restriction by the pylorus, decreased ghrelin, increased satiety, increased gastric emptying, and faster small bowel transit times with a component of malabsorption.
|
The RYGB connects a limb of the intestine to a much smaller stomach pouch, which prevents the bile from entering the upper part of the stomach and esophagus, thereby effectively bypassing the remaining stomach and first segment of the small intestine.
Other Names:
The SG is a restrictive procedure in which a partial left gastrectomy of the fundus and body of the stomach is performed in order to create a long tubular "sleeve" along the lesser curvature.
The weight loss and resolution of comorbidities are attributed not only to the restrictive nature of the procedure but also to restriction by the pylorus, decreased ghrelin, increased satiety, increased gastric emptying, and faster small bowel transit times with a component of malabsorption
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Intra-Operative Data:
Time Frame: January 1, 2017 -May 2020
|
Operative time
|
January 1, 2017 -May 2020
|
Post-Operative Data (up to discharge)
Time Frame: January 1, 2017 -May 2020
|
Post-operative data collection such as adverse events, discharge status, hospital length of stay, information on enhanced recovery program
|
January 1, 2017 -May 2020
|
Short-Term Follow-Up Data (up to 30 days post-discharge):
Time Frame: January 1, 2017 -May 2020
|
Data collection of events such as Adverse events up to 30 days, re- admissions, re-operations related to the index procedure
|
January 1, 2017 -May 2020
|
Pre-Operative Information:
Time Frame: January 1, 2017 -May 2020
|
Collection of Demographics data: gender, age in years Collection of pre-operative medical history: diabetes status, cardiopulmonary disease, hypertension diagnosis, previous abdominal surgery Collection of Demographics patient characteristics: BMI, ASA Class, tobacco use
|
January 1, 2017 -May 2020
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Sachin S Kukreja, MD, Methodist Dallas Medical Center
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- 015.WMP.2020.D
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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