General Surgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
General Surgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt.
BMJ Open Qual. 2023 Jan;12(1). doi: 10.1136/bmjoq-2022-002068.
Minimally invasive surgery has been steadily growing in popularity. Control of splenic hilar vessels is the most delicate step during laparoscopic splenectomy (LS). In the earlier eras of LS, hilar vessels were controlled using clips and/or ligation. Laparoscopic staples were later introduced and have arguably led to an increase in popularity of LS. They do not abolish potential complications of splenectomy and theoretically represent an added operative cost.In this study, we aimed to assess the safety and efficacy of stapleless LS (using knots, haemostatic devices and clips) compared with the now more conventional stapled LS.
A pilot randomised prospective study was conducted in a university hospital between September 2018 and April 2020. It included 40 patients randomly assigned to two equal groups: (1) 20 patients: stapleless LS and (2) 20 patients: LS using laparoscopic staples.We compared operative time, intra and postoperative complications and postoperative recovery.
There was no statistically significant difference between both groups across all comparative outcomes.
Both techniques are comparable in terms of safety and operative time. In terms of cost efficiency, we recommend more comprehensive analyses of hospital costs.
微创外科一直在稳步发展。在腹腔镜脾切除术（LS）中，控制脾门血管是最关键的步骤。在 LS 的早期阶段，使用夹子和/或结扎来控制脾门血管。后来引入了腹腔镜吻合器，这可能导致 LS 的普及度增加。它们并没有消除脾切除的潜在并发症，理论上代表了额外的手术成本。在这项研究中，我们旨在评估无钉 LS（使用结、止血装置和夹子）与现在更常规的钉 LS 的安全性和有效性。
一项在大学医院进行的前瞻性随机试点研究于 2018 年 9 月至 2020 年 4 月进行。它纳入了 40 名随机分配到两组的患者：（1）20 名患者：无钉 LS；（2）20 名患者：使用腹腔镜吻合器的 LS。我们比较了手术时间、围手术期并发症和术后恢复情况。
两组在所有比较结果方面均无统计学差异。
两种技术在安全性和手术时间方面具有可比性。在成本效益方面，我们建议对医院成本进行更全面的分析。
