Comparing Minimally Invasive Bariatric Techniques: A Systematic Review of Robotic Sleeve Gastrectomy vs. Endoscopic Sleeve Gastroplasty

Background Within bariatric surgery, endoscopic sleeve gastroplasty (ESG) and robotic sleeve gastrectomy (RSG) have emerged as minimally invasive procedures for weight loss and metabolic management. While both offer benefits for obesity, the comparative effects in terms of weight loss, efficacy, and safety remain uncertain. Methods A systematic search of PubMed/MEDLINE, and Cochrane Library was conducted to collect both prospective and retrospective studies assessing the effectiveness and safety of RSG and ESG in treating morbid obesity. Regression analysis was performed. Results We collected eleven studies (1182 patients) evaluating RSG and fourteen studies (3077 patients) evaluating ESG. Average patient ages for RSG were 42.79±11.31 years (63.9% females) with preoperative Body Mass Index of 47.81+8.00 and 38.52±9.69 years (86.1% females) with BMI of 35.20±4.29 for ESG. Mean operation time was 104.93 minutes for RSG, and 68.4 for ESG. RSG yielded a Estimated Weight Loss % (%EWL) of 51.26% at 18 months, while ESG yielded 73.01%. Complication rates were 2.71% (32/1182) for RSG and 8.88% (273/3077) for ESG, while reoperation rates were 0.59% for RSG and 1.34% for ESG. Average hospital stays were 2.71 days for RSG and 0.68 days for ESG. Conclusion The long-term clinical results of RSG and ESG for morbid obesity show similarly favorable outcomes. ESG has shorter operative times and hospital stays, but more complications. Additional research with larger cohorts and randomized trials is needed to determine the preferred procedure.