Biju Pottakkat, Gurram Ram Prakash, Kalayarasan Raja, Krishna Pothugunta S
Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND.
Cureus. 2023 Aug 20;15(8):e43820. doi: 10.7759/cureus.43820. eCollection 2023 Aug.
Introduction The utilization of robot-assisted technique for splenectomy has recently gained popularity especially in patients undergoing splenectomy for hematological indications owing to its magnification of and easy manipulation of internal abdominal organs. Moreover, robotic splenectomy emerged as an essential teaching module before approaching more complex robotic procedures. Methods A total of 43 elective splenectomies were performed for hematological indications in Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) between January 2018 to July 2023 of which 14 patients underwent robotic splenectomy. All patients underwent lateral approach of robotic splenectomy with a modification of avoiding the lesser sac dissection. Prospectively maintained data were retrospectively analyzed and results were recorded in terms of intra-operative time taken, blood loss, need for blood and blood product transfusion and postoperative morbidity and mortality. Results The indications for patients who underwent robotic splenectomy include idiopathic thrombocytopenic purpura in eight patients, autoimmune hemolytic anemia in three patients, Evans syndrome in one patient and hereditary spherocytosis in two patients. The median splenic diameter was 14.8cm and the median platelet count before the operation was 10,800 cells/cubic millimeter (7000-3,20,000). The mean operative time was 92 minutes and blood loss was 40ml. The median duration of hospital stay was 2.4 days. All 14 patients had therapeutic success and there was no procedure-related mortality or morbidity. Conclusion Robotic splenectomy using the modified lateral approach can safely be performed with comparable operative time, blood loss and overall morbidity. However further studies are mandatory to confirm the advantage of this modified technique of lateral approach of robotic splenectomy.
引言 机器人辅助技术在脾切除术中的应用近来颇受青睐，尤其是对于因血液系统疾病而行脾切除术的患者，这是由于该技术能够放大并便于操作腹腔内器官。此外，在开展更复杂的机器人手术之前，机器人脾切除术已成为一项重要的教学模块。方法 在2018年1月至2023年7月期间，贾瓦哈拉尔研究生医学教育与研究学院（JIPMER）外科胃肠病学系对43例因血液系统疾病而行择期脾切除术的患者进行了手术，其中14例患者接受了机器人脾切除术。所有患者均采用机器人脾切除术的外侧入路，并改良为避免小网膜囊解剖。对前瞻性收集的数据进行回顾性分析，并记录手术时间、失血量、输血及血液制品需求以及术后发病率和死亡率等结果。结果 接受机器人脾切除术的患者的适应证包括：8例特发性血小板减少性紫癜、3例自身免疫性溶血性贫血、1例伊文氏综合征和2例遗传性球形红细胞增多症。脾的中位直径为14.8cm，术前血小板计数中位数为10,800个/立方毫米（7000 - 320,000）。平均手术时间为92分钟，失血量为40ml。中位住院时间为2.4天。所有14例患者均取得治疗成功，且无手术相关的死亡率或发病率。结论 使用改良外侧入路的机器人脾切除术能够安全实施，手术时间、失血量和总体发病率相近。然而，需要进一步研究以证实这种改良的机器人脾切除外侧入路技术的优势。
