Gelmini Roberta, Franzoni Chiara, Spaziani Alessandro, Patriti Alberto, Casciola Luciano, Saviano Massimo
Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy.
J Laparoendosc Adv Surg Tech A. 2011 Jun;21(5):393-8. doi: 10.1089/lap.2010.0564. Epub 2011 May 11.
Laparoscopic splenectomy is accepted as a safe approach in the surgical treatment of blood disorders worldwide. Compared with the laparotomic technique, it is associated with a lower risk of intraoperative bleeding, less postoperative pain, and faster discharge times. The advent of robotic surgery (RS) has changed the concept of minimally invasive surgery because, in addition to allowing a three-dimensional view, it permits greater freedom of movement and higher levels of accuracy than laparoscopic surgery (LS). The aim of this study was to comparatively evaluate whether RS presents advantages over LS in spleen surgery.
In two Surgical Units with experience in laparoscopic splenectomy, over a 7-year period, two groups of 45 patients underwent LS and RS. The two groups were well matched for demographic characteristics, indications, and spleen size.
No statistically significant differences were found regarding intraoperative blood loss, conversion rate to laparotomy, food intake, drain removal, postoperative complications, and median time to discharge. On the contrary, statistically increased differences were observed in median operative time and costs. In both groups, the transfusion and mortality rate was 0%. At the 6-month follow-up no surgical complications were observed.
Although RS offers a three-dimensional view, greater freedom of movement, and higher levels of accuracy, it is associated with longer operative times and higher costs. It can consequently be concluded that with the intrinsic limits of the study design used, at the current time, RS does not have any significant advantage over LS in splenectomy.
腹腔镜脾切除术在全球范围内被公认为是治疗血液系统疾病的一种安全手术方法。与开腹手术相比，它具有术中出血风险更低、术后疼痛更少、出院时间更快的特点。机器人手术（RS）的出现改变了微创手术的概念，因为它除了能提供三维视野外，还比腹腔镜手术（LS）具有更大的活动自由度和更高的准确性。本研究的目的是比较评估机器人手术在脾脏手术中是否比腹腔镜手术具有优势。
在两个有腹腔镜脾切除术经验的外科科室，在7年的时间里，两组各45例患者分别接受了腹腔镜手术和机器人手术。两组在人口统计学特征、适应证和脾脏大小方面匹配良好。
在术中出血量、开腹转换率、食物摄入量、引流管拔除、术后并发症和中位出院时间方面未发现统计学上的显著差异。相反，在中位手术时间和费用方面观察到统计学上的显著差异。两组的输血率和死亡率均为0%。在6个月的随访中未观察到手术并发症。
尽管机器人手术提供了三维视野、更大的活动自由度和更高的准确性，但它与更长的手术时间和更高的费用相关。因此可以得出结论，在所采用的研究设计存在固有局限性的情况下，目前机器人手术在脾切除术中并不比腹腔镜手术具有任何显著优势。
