Comparing laparoscopic and robotic splenectomy: A systematic review of the outcomes.

IF 1.1 4区 医学 Q3 SURGERY
K Madan, Ramya B Sriram, Siddharth Davuluri
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引用次数: 0

Abstract

Abstract: Splenectomy can be performed using various surgical approaches, including open, laparoscopic (LS), and robotic splenectomy (RS). While LS has been the mainstay for many years, it is associated with a steep learning curve and increased rates of morbidity and conversion to open surgery in complex cases such as splenomegaly, obesity, haematological malignancies, and patients with prior laparotomies. RS has emerged as a technique that facilitates a spleen-focused dissection, potentially reducing anatomical disruption and operative risk. This systematic review aimed to compare the peri-operative outcomes of LS and RS in non-traumatic indications for splenectomy. A comprehensive search was conducted in MEDLINE, Embase, CINAHL, and CENTRAL databases, along with searches for unpublished and ongoing studies through the World Health Organization platform. Data extraction was standardized using a pre-tested collection form, and statistical methods were employed to derive mean values where only medians and interquartile ranges were reported. The results demonstrated that the mean operative time was longer in the RS group, although the difference was not statistically significant. Conversion to open surgery occurred in 12 LS cases compared to 2 RS cases. Post-operative complications were more frequent in the LS group (9 patients) compared to the RS group (1 patient), with most complications observed after 24 hours. The mean length of hospital stay was similar between groups (6.0 days for RS vs. 6.5 days for LS; P = 0.89). RS was associated with lower mean intraoperative blood loss compared to LS. In conclusion, RS may offer advantages over LS in terms of reduced blood loss, lower conversion rates, and fewer postoperative complications, although it does not significantly impact hospital stay duration or cost-effectiveness and is associated with longer operative time.

比较腹腔镜和机器人脾切除术:结果的系统回顾。
脾切除术可采用多种手术方式进行,包括开放、腹腔镜(LS)和机器人脾切除术(RS)。虽然LS多年来一直是主流,但它与陡峭的学习曲线和发病率增加以及在复杂病例(如脾肿大,肥胖,血液恶性肿瘤和先前有剖腹手术的患者)转向开放手术相关。RS作为一种技术已经出现,可以促进脾脏集中的解剖,潜在地减少解剖破坏和手术风险。本系统综述旨在比较LS和RS在非外伤性脾切除术指征中的围手术期结果。在MEDLINE、Embase、CINAHL和CENTRAL数据库中进行了全面的搜索,并通过世界卫生组织平台搜索了未发表和正在进行的研究。使用预测试的收集表格对数据提取进行标准化,并采用统计方法推导平均值,其中仅报告中位数和四分位数范围。结果显示,RS组的平均手术时间更长,但差异无统计学意义。12例LS患者转为开腹手术,2例RS患者转为开腹手术。LS组(9例)术后并发症发生率高于RS组(1例),且以24小时后出现的并发症居多。两组患者的平均住院时间相似(RS组为6.0天,LS组为6.5天;P = 0.89)。与LS相比,RS的平均术中出血量更低。总之,RS在减少出血量、降低转换率和减少术后并发症方面可能比LS有优势,尽管它对住院时间或成本效益没有显著影响,并且与较长的手术时间相关。
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
CiteScore
1.70
自引率
0.00%
发文量
151
审稿时长
36 weeks
期刊介绍: Journal of Minimal Access Surgery (JMAS), the official publication of Indian Association of Gastrointestinal Endo Surgeons, launched in early 2005. The JMAS, a quarterly publication, is the first English-language journal from India, as also from this part of the world, dedicated to Minimal Access Surgery. The JMAS boasts an outstanding editorial board comprising of Indian and international experts in the field.
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