Robotic versus laparoscopic splenectomy: a systematic review of perioperative outcomes

Anantha Shreepad Bhat,Alexia Farrugia,Jawad Ahmad,Qazi Rahim Muhammad,Gabriele Marangoni,Viera Kulikova

doi:10.1007/s10353-021-00727-7

Abstract

Summary Background Elective splenectomy has various indications and can be performed open or minimally invasively. Laparoscopic splenectomy (LS) is popular but has limitations. Some studies suggest potential superiority of robotic splenectomy (RS) over LS. As such, we conducted a systematic review to determine whether RS has greater positive perioperative outcomes in comparison to LS in the adult population. Methods We searched for studies that reported perioperative outcomes and compared RS to LS in the adult population. Outcome measures were operative time, conversion to open surgery, postoperative complications, mortality, length of stay, blood loss and cost analysis. A simple, unpaired two-tailed student’s t‑test was used to compare outcomes between the RS and LS patient groups. Results After full-text analysis of 47 papers, three studies met the inclusion criteria. The studies involved 72 patients (28 in the RS group, 44 in the LS group). RS demonstrated no significantly reduced blood loss in comparison to LS (p = 0.13). RS had no cases converting to open surgery and no postoperative complications in comparison to LS. No significant difference was found between RS and LS with regards to LOS (p = 0.89) and cost benefit (p = 0.74). RS had a higher operative time in comparison to LS which was not statistically significant (p = 0.45). Conclusion The RS approach may be associated with lower blood loss and a lower risk of conversions. There was no statistical difference between RS and LS with regards to length of stay (LOS) and cost. RS takes longer to perform in comparison to LS.

Highlights

Elective splenectomy has many indications and can be performed via an open approach or in a minimally invasive manner [1]
This study is novel in that it is the first systematic review to compare robotic and laparoscopic perioperative outcomes in solely the adult population While acknowledging the historically immense contributions of general surgeons improving perioperative outcomes of both robotic and laparoscopic splenectomies, this study provides a snapshot of the current state of play in the field, while providing definitive suggestions to encourage further studies to compare these surgical modalities in a robust manner
We conducted a systematic review to determine whether robotic splenectomy (RS) has greater positive perioperative outcomes in comparison to laparoscopic splenectomy (LS) in the adult population

Summary

Introduction

Elective splenectomy has many indications and can be performed via an open approach or in a minimally invasive manner [1]. With the introduction and increasing availability of the surgical robot in the operative arena [9, 10], general surgeons are adopting the robotic platform to benefit from its markedly advanced endowristed instruments [11]. While both laparoscopic and robotic surgery are classed as minimally invasive techniques, there are studies which appear to suggest superiority of robotic splenectomy (RS) over the laparoscopic approach [12, 13]

Methods

Results

Conclusion