A comparison of robotic-assisted splenectomy and laparoscopic splenectomy for children with hematologic disorders

Shelby, Rita D.; Kulaylat, Afif N.; Villella, Anthony; Michalsky, Marc P.; Diefenbach, Karen A.; Aldrink, Jennifer H.

doi:10.1016/j.jpedsurg.2020.08.031

Cited by 23 publications

(14 citation statements)

References 37 publications

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“…Intraoperative bleeding from the splenic hilum is known to be an independent risk factor for conversion to open splenectomy in patients undergoing elective robotic or laparoscopic splenectomy. 25 Although the volume of blood loss was different between 2 groups in this metaanalysis, conversion to open rates between the robotic and laparoscopic groups were similar. It has to be taken into account that the included studies poorly reported the confounding factors associated with risk of intraoperative bleeding in minimally invasive splenectomy including BMI, size and weight of spleen, perioperative platelets levels, etc.…”

Section: Discussionmentioning

confidence: 66%

“…Further, 6 studies were excluded as 2 were comparing outcomes of minimally invasive splenectomy with the open approach, 2 evaluated outcomes of distal splenectomy with splenectomies and 1 was a review article. Therefore, 8 comparative retrospective observational studies [18][19][20][21][22][23][24][25] were deemed appropriate for inclusion (Figure 1). The total number of included patients was 560 patients of whom 202 underwent robotic splenectomy and the remaining 358 patients underwent laparoscopic splenectomy.…”

Section: Resultsmentioning

confidence: 99%

“…The comparative outcomes of robotic vs. laparoscopic splenectomy were evaluated by a comprehensive systematic review and meta-analysis which included 8 comparative studies [18][19][20][21][22][23][24][25] enrolling a total of 560 patients of whom 202 underwent robotic splenectomy and the remaining 358 patients underwent laparoscopic splenectomy. The robotic splenectomy was found to be associated with significantly lower volume of blood loss than the laparoscopic approach, although it lost its statistical significance in leave-one-out sensitivity analysis.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Robotic vs. Laparoscopic Splenectomy in Management of Non-traumatic Splenic Pathologies: A Systematic Review and Meta-Analysis

Bhattacharya

Phelan

Fisher

et al. 2021

The American Surgeon™

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We aimed to evaluate comparative outcomes of robotic and laparoscopic splenectomy in patients with non-traumatic splenic pathologies. A systematic search of electronic databases and bibliographic reference lists were conducted, and a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in electronic databases were applied. Intraoperative and post-operative complications, wound infection, haematoma, conversion to open procedure, return to theatre, volume of blood loss, procedure time and length of hospital stay were the evaluated outcome parameters. We identified 8 comparative studies reporting a total of 560 patients comparing outcomes of robotic ( n = 202) and laparoscopic ( n = 258) splenectomies. The robotic approach was associated with significantly lower volume of blood loss (MD: −82.53 mls, 95% CI −161.91 to −3.16, P = .04) than the laparoscopic approach. There was no significant difference in intraoperative complications (OR: 0.68, 95% CI .21-2.01, P = .51), post-operative complications (OR: .91, 95% CI .40-2.06, P = .82), wound infection (RD: -.01, 95% CI -.04-.03, P = .78), haematoma (OR: 0.40, 95% CI .04-4.03, P = .44), conversion to open (OR: 0.63; 95% CI, .24-1.70, P = .36), return to theatre (RD: −.04, 95% CI -.09-.02, P = .16), procedure time (MD: 3.63; 95% CI -16.99-24.25, P = .73) and length of hospital stay (MD: −.21; 95% CI -1.17 - .75, P = .67) between 2 groups. In conclusion, robotic and laparoscopic splenectomies seem to have comparable perioperative outcomes with similar rate of conversion to an open procedure, procedure time and length of hospital stay. The former may potentially reduce the volume of intraoperative blood loss. Future higher level research is required to evaluate the cost-effectiveness and clinical outcomes

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Section: Discussionmentioning

confidence: 66%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Robotic vs. Laparoscopic Splenectomy in Management of Non-traumatic Splenic Pathologies: A Systematic Review and Meta-Analysis

Bhattacharya

Phelan

Fisher

et al. 2021

The American Surgeon™

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“…In 2020, a direct comparison between 10 RAS and 14 LA splenectomies for hematologic disorders was carried out [ 42 ]. Children underwent surgery between 2014 and 2019 and were on average at least 9.9 years old.…”

Section: Resultsmentioning

confidence: 99%

Robotically Assisted Surgery in Children—A Perspective

Krebs

Schnorr

Heye³

et al. 2022

Children

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The introduction of robotically assisted surgery was a milestone for minimally invasive surgery in the 21st century. Currently, there are two FDA-approved robotically assisted surgery systems for use and development in pediatrics. Specifically, tremor filtration and optimal visualization are approaches which can have enormous benefits for procedures in small bodies. Robotically assisted surgery in children might have advantages compared to laparoscopic or open approaches. This review focuses on the research literature regarding robotically assisted surgery that has been published within the past decade. A literature search was conducted to identify studies comparing robotically assisted surgery with laparoscopic and open approaches. While reported applications in urology were the most cited, three other fields (gynecology, general surgery, and “others”) were also identified. In total, 36 of the publications reviewed suggested that robotically assisted surgery was a good alternative for pediatric procedures. After several years of experience of this surgery, a strong learning curve was evident in the literature. However, some authors have highlighted limitations, such as high cost and a limited spectrum of small-sized instruments. The recent introduction of reusable 3 mm instruments to the market might help to overcome these limitations. In the future, it can be anticipated that there will be a broader range of applications for robotically assisted surgery in selected pediatric surgeries, especially as surgical skills continue to improve and further system innovations emerge.

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“…Laparoscopic splenectomy is the standard of surgical care. Robot-assisted splenectomy is an option and is associated with a shorter length of hospital stay compared to laparoscopic splenectomy [126].…”

Section: Splenectomymentioning

confidence: 99%

Robotic-Assisted Minimally Invasive Surgery in Children

Navarrete-Arellano¹

2021

Latest Developments in Medical Robotics Systems

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Currently, minimally invasive surgery (MIS) includes conventional laparo-thoracoscopic surgery and robot-assisted surgery (RAS) or robotic surgery. Robotic surgery is performed with robotic devices, for example the Da Vinci system from Intuitive Surgical, which has a miniaturized camera capable of image magnification, a three-dimensional image of the surgical field, and the instruments are articulated with 7 degrees of freedom of movement, and the surgeon operates in a sitting position at a surgical console near the patient. Robotic surgery has gained an enormous surge in use on adults, but it has been slowly accepted for children, although it offers important advantages in complex surgeries. The areas of application of robotic surgery in the pediatric population include urological, general surgery, thoracic, oncological, and otorhinolaryngology, the largest application has been in urological surgery. There is evidence that robotic surgery in children is safe and it is important to offer its benefits. Intraoperative complications are rare, and the frequency of postoperative complications ranges from 0–15%. Recommendations for the implementation of a pediatric robotic surgery program are included. The future will be fascinating with upcoming advancements in robotic surgical systems, the use of artificial intelligence, and digital surgery.

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A comparison of robotic-assisted splenectomy and laparoscopic splenectomy for children with hematologic disorders

Cited by 23 publications

References 37 publications

Robotic vs. Laparoscopic Splenectomy in Management of Non-traumatic Splenic Pathologies: A Systematic Review and Meta-Analysis

Robotic vs. Laparoscopic Splenectomy in Management of Non-traumatic Splenic Pathologies: A Systematic Review and Meta-Analysis

Robotically Assisted Surgery in Children—A Perspective

Robotic-Assisted Minimally Invasive Surgery in Children

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