Department of Surgery, The Ohio State University College of Medicine, Columbus, OH.
Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
J Pediatr Surg. 2021 May;56(5):1047-1050. doi: 10.1016/j.jpedsurg.2020.08.031. Epub 2020 Sep 8.
Laparoscopic splenectomy (LS) is the standard of care for hematologic disorders requiring splenectomy. Less is known about the outcomes following robotic-assisted splenectomy (RS) for this indication. Our aim was to describe outcomes of RS to LS in pediatric patients with hematologic disorders in our institution.
A single institution retrospective review was performed of pediatric patients undergoing LS vs. RS from 2014 to 2019. Patient demographics, diagnosis, spleen size, hospital length of stay (LOS), operative time, post-operative opioid use, and hospital charges were evaluated. Standard univariate analyses were performed.
Twenty-four patients were included in the study (14 LS, 10 RS). The mean spleen size at the time of surgery was larger in the RS group compared to LS (14.5 cm vs. 12.2 cm, p = 0.03). Operative time between the two cohorts was comparable (RS 140.5 vs LS 154.9 min). Median LOS for RS was shorter than LS (2.1 vs. 3.2 days, p = 0.02). Cumulative postoperative opioid analgesic requirements were not significantly different between the groups (17.4 mg vs. 30.5 mg). The median hospital charges, including the surgical procedure and hospital stay were higher in the RS group ($44,724 RS vs $30,255 LS, p = 0.01).
Robotic splenectomy is a safe and feasible option for pediatric patients with hematologic disorders, and was associated with decreased LOS but higher charges compared to laparoscopic splenectomy. Further studies are required to delineate the optimal use and potential benefits of robot-assisted surgical techniques in children.
II.
腹腔镜脾切除术（LS）是治疗需要脾切除术的血液系统疾病的标准治疗方法。对于这种适应证，机器人辅助脾切除术（RS）的结果知之甚少。我们的目的是描述我院小儿血液系统疾病患者行 RS 转为 LS 的结果。
对 2014 年至 2019 年期间行 LS 与 RS 的小儿患者进行了单中心回顾性研究。评估了患者的人口统计学特征、诊断、脾脏大小、住院时间（LOS）、手术时间、术后阿片类药物使用和住院费用。进行了标准的单变量分析。
本研究共纳入 24 例患者（14 例行 LS，10 例行 RS）。RS 组手术时脾脏大小大于 LS 组（14.5cm 比 12.2cm，p=0.03）。两组手术时间相当（RS 组 140.5 分钟，LS 组 154.9 分钟）。RS 组的中位 LOS 短于 LS 组（2.1 天比 3.2 天，p=0.02）。两组术后累积阿片类药物镇痛需求无显著差异（17.4mg 比 30.5mg）。RS 组的中位住院费用（包括手术和住院费用）高于 LS 组（44724 美元比 30255 美元，p=0.01）。
对于血液系统疾病的小儿患者，机器人脾切除术是一种安全可行的选择，与腹腔镜脾切除术相比，它具有较短的 LOS，但费用较高。需要进一步研究阐明机器人辅助手术技术在儿童中的最佳应用和潜在益处。
II 级。
