Robotic Versus Total Laparoscopic Splenectomy With Pericardial Devascularisation for Portal Hypertension: A Retrospective Cohort Study

IF 2.3 3区医学 Q2 SURGERY

International Journal of Medical Robotics and Computer Assisted Surgery Pub Date : 2025-06-24 DOI:10.1002/rcs.70085

Zhen Ma, Hongbin Cui, Lei Gaoi, Bin Ma, Puyi He, Yang Yu, Yunpeng Wang, Yanling Ma, Hao Chen

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引用次数: 0

Abstract

Background

This study compared the feasibility, efficacy, and safety of robotic splenectomy with pericardial devascularisation (TRSPD) versus total laparoscopic splenectomy with pericardial devascularisation (TLSPD) in patients with portal hypertension (PHT) complicated by splenomegaly, hypersplenism, and oesophagogastric varices.

Methods

A retrospective cohort analysis was conducted on 17 patients undergoing minimally invasive splenectomy with pericardial devascularisation between 2022 and 2024. Outcomes included operative metrics, postoperative recovery, and portal hypertension resolution.

Results

TRSPD significantly reduced intraoperative blood loss (175 vs. 436 mL, p = 0.004) despite longer operative duration (400 vs. 256 min, p = 0.001). Zero conversions occurred with TRSPD versus 3 conversions with TLSPD (p = 0.02). Postoperatively, TRSPD accelerated gastrointestinal recovery (2.1 vs. 3.5 days, p = 0.02) and shortened drainage duration (4.0 vs. 6.2 days, p = 0.02). Both techniques normalised haematologic indices, reduced portal vein diameter (p < 0.05), and resolved varices without major complications.

Conclusions

TRSPD demonstrates superior intraoperative safety and faster recovery compared with TLSPD while achieving equivalent therapeutic efficacy for portal hypertension. Robotic approaches may optimise the minimally invasive management of complex portosplenic vascular pathologies.

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机器人与全腹腔镜脾切除术合并心包断流术治疗门静脉高压：一项回顾性队列研究

本研究比较了机器人脾切除术合并心包断流术（TRSPD）与全腹腔镜脾切除术合并心包断流术（TLSPD）治疗门脉高压（PHT）合并脾肿大、脾功能亢和食管胃静脉曲张的可行性、有效性和安全性。方法回顾性分析2022 ~ 2024年间行微创脾切除术合并心包断流术的17例患者。结果包括手术指标、术后恢复和门静脉高压缓解。结果尽管手术时间较长（400 vs 256 min, p = 0.001），但TRSPD显著减少术中出血量（175 vs 436 mL, p = 0.004）。TRSPD组为0例，TLSPD组为3例（p = 0.02）。术后TRSPD加速胃肠恢复（2.1 vs. 3.5天，p = 0.02），缩短引流时间（4.0 vs. 6.2天，p = 0.02）。两种技术均使血液学指标正常化，门静脉直径减小(p <；0.05)，静脉曲张消退，无重大并发症。结论与TLSPD相比，TRSPD术中安全性更高，恢复速度更快，治疗门静脉高压症的效果相当。机器人入路可以优化复杂门脾血管病变的微创治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Medical Robotics and Computer Assisted Surgery 医学-外科

CiteScore

4.50

自引率

12.00%

发文量

131

审稿时长

6-12 weeks

期刊介绍： The International Journal of Medical Robotics and Computer Assisted Surgery provides a cross-disciplinary platform for presenting the latest developments in robotics and computer assisted technologies for medical applications. The journal publishes cutting-edge papers and expert reviews, complemented by commentaries, correspondence and conference highlights that stimulate discussion and exchange of ideas. Areas of interest include robotic surgery aids and systems, operative planning tools, medical imaging and visualisation, simulation and navigation, virtual reality, intuitive command and control systems, haptics and sensor technologies. In addition to research and surgical planning studies, the journal welcomes papers detailing clinical trials and applications of computer-assisted workflows and robotic systems in neurosurgery, urology, paediatric, orthopaedic, craniofacial, cardiovascular, thoraco-abdominal, musculoskeletal and visceral surgery. Articles providing critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies, commenting on ease of use, or addressing surgical education and training issues are also encouraged. The journal aims to foster a community that encompasses medical practitioners, researchers, and engineers and computer scientists developing robotic systems and computational tools in academic and commercial environments, with the intention of promoting and developing these exciting areas of medical technology.