{"title":"比较腹腔镜和机器人脾切除术:结果的系统回顾。","authors":"K Madan, Ramya B Sriram, Siddharth Davuluri","doi":"10.4103/jmas.jmas_330_24","DOIUrl":null,"url":null,"abstract":"<p><strong>Abstract: </strong>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 A comprehensive search was conducted in MEDLINE, Embase, CINAHL, and CENTRAL databases, along with searches for unpublished and ongoing studies through the World Health Organization platform.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.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.1000,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparing laparoscopic and robotic splenectomy: A systematic review of the outcomes.\",\"authors\":\"K Madan, Ramya B Sriram, Siddharth Davuluri\",\"doi\":\"10.4103/jmas.jmas_330_24\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Abstract: </strong>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.</p>\",\"PeriodicalId\":48905,\"journal\":{\"name\":\"Journal of Minimal Access Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2025-07-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Minimal Access Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4103/jmas.jmas_330_24\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Minimal Access Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4103/jmas.jmas_330_24","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
Comparing laparoscopic and robotic splenectomy: A systematic review of the outcomes.
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.
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.