Robotic vs laparoscopic splenectomy for splenomegaly: A retrospective comparative cohort study

Cavaliere, Davide; Solaini, Leonardo; Pietrantonio, Daniela Di; D’Acapito, Fabrizio; Tauceri, Francesca; Framarini, Massimo; Ercolani, Giorgio

doi:10.1016/j.ijsu.2018.05.012

Cited by 26 publications

(23 citation statements)

References 16 publications

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“…The operative time was longer in the robotic group in the ROLARR trial, but this could be attributed to the status of the learning curve in robotic rectal surgery of the participating surgeons. As robotic procedures have always been associated with longer operative times as compared to laparoscopy in several general surgery procedures, 2–5 , 18 , 19 we believe that this result for rectal surgery further supports the hypothesis that the use of the robotic platform may be particularly indicated for rectal cancer surgery.…”

Section: Discussionsupporting

confidence: 67%

Average treatment effect of robotic versus laparoscopic rectal surgery for rectal cancer

Solaini

Perna

Cavaliere

et al. 2020

Robotics Computer Surgery

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BACKGROUND The aim of this study is to estimate what would have happened if all patients treated with laparoscopy for rectal cancer had instead been treated with the robotic technique. METHODS To estimate the average treatment effect (ATE) of the robotic technique over the laparoscopic approach, data from patients treated at two centres between 2007 and 2018 were used to obtain counterfactual outcomes using an inverse probability weighting (IPW) adjustment. RESULTS This study enrolled 261 patients, of which 177 and 84 patients had undergone robotic surgery and standard laparoscopy, respectively. After IPW adjustment, the difference between the groups was similar in the pseudo‐population. The average conversion rate would fall by an estimated 6.1% if all procedures had been robotic (p = 0.045). All other post‐operative variables showed no differences regardless of the approach. CONCLUSION ATE estimation suggests that robotic rectal cancer surgery could be associated with a lower conversion rate. The approach did not affect the post‐operative morbidity rates or the operative time.

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Section: Discussionsupporting

confidence: 67%

Average treatment effect of robotic versus laparoscopic rectal surgery for rectal cancer

Solaini

Perna

Cavaliere

et al. 2020

Robotics Computer Surgery

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“…Currently, with the advanced minimally invasive method, robotic splenectomy has been used for first training of robotic systems and routine clinical practice. Cavaliere et al suggest robotic splenectomy due to less intraoperative bleeding for splenomegaly (26). On the other hand, Bodner et al and Gelmini et al have reported that robotic surgery is not cost-effective and the operation time is longer than in LS (27,28).…”

Section: Discussionmentioning

confidence: 99%

Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy

et al. 2020

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“…The efficacy of this technology is greater than the classic laparoscopy and the results have been better, especially when using a single port with less inflammatory organic response to the surgical trauma. In a few years, the robotic approaches will be the standard option for most surgeries of all specialities, even in elderly patients [1,2,21].…”

Section: Opsoninsmentioning

confidence: 99%

“…In such cases, a subtotal splenectomy is recommended to alleviate the symptoms and to improve the results of chemotherapy, without reducing the patient's immune defences, followed by severe sepsis and precocious death due to an asplenic condition if a total splenectomy needs to be performed. The advances of imaging methods and imaging guided biopsies have been enough to define the stage of oncological diseases, including Hodgkin's and non-Hodgkin's lymphomas; therefore, surgical procedures must be avoided [21,26,27,28,29] .…”

Section: Splenic Diseases In the Elderlymentioning

confidence: 99%

The Spleen and Spleen Surgery in the Elderly

Petroianu

2018

International Journal of Hematology Research

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The spleen is a very important organ with many essential functions, not only in the defense of the organism, but also in its metabolic, immunological and haematological systems. The most common manifestations of the splenic disturbances include splenomegaly and a decrease in the number of blood elements. After the removal of the spleen, 2% of adults present severe sepsis, while more than 10% of the elderly are at risk of death due to septic conditions. Most splenic diseases can be treated conservatively. Operative procedures should be considered in special conditions, when all conservative options have been unsuccessfully depleted. Even in the presence of a severe trauma to the spleen or advanced haematological diseases, the best approach is a non-operative procedure. When the operation is unavoidable, partial and subtotal splenectomies or implants of autogenous splenic tissue onto the greater omentum should be performed. At least 25% of a normal spleen should be left with drainage to the portal system to preserve the complete efficacy of all splenic functions. The technological advances and the progressive development of new surgical devices are responsible for laparoscopy with or without robotic assistance. These surgical approaches lead to less pain, faster postoperative recovery and better cosmetic results, without decreasing the therapeutic efficacy. The conservative splenic approach, whether clinical or surgical, is the best way to prevent postsplenectomy infection, by preserving the spleen's role in immunity.

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Robotic vs laparoscopic splenectomy for splenomegaly: A retrospective comparative cohort study

Abstract: Robotic splenectomy for splenomegaly is associated with less blood loss and longer operative times than the laparoscopic procedure.

Cited by 26 publications

References 16 publications

Average treatment effect of robotic versus laparoscopic rectal surgery for rectal cancer

Average treatment effect of robotic versus laparoscopic rectal surgery for rectal cancer

Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy

The Spleen and Spleen Surgery in the Elderly

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