Robotic versus laparoscopic splenectomy: a systematic review of perioperative outcomes

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.

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Craniometrics and Perioperative Variants in Non-Syndromic Single Suture Craniosynostosis with Cranial Vault Remodelling Surgery and Strip Craniotomy with and without Endoscopic Assistance: Systematic Review

QJM ◽

10.1093/qjmed/hcab108 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Hazem Ahmed Moustafa ◽

Walid Ahmed Abdel Ghany ◽

Assem Mounir Abdel Latif ◽

Abdelrahman Elsayed Mohammed Elsabagh

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Open Surgery ◽

Minimal Invasive ◽

Cosmetic Outcome ◽

Cranial Vault ◽

Perioperative Outcomes ◽

Syndromic Craniosynostosis ◽

Significant Difference

Abstract Background Craniosynostosis is a major category in craniofacial anomalies defined as premature closure of one or more of cranial sutures. Diagnostic Indices and different measures and landmark points are being chosen according to age, the type of deformity and its severity, surgical procedure and targeted cosmetic outcome. Objectives Primary objective is to compare anthropometric measures Post-operative in short and long term follow up between different surgical modalities and impact on cosmetic outcome and need of second corrective surgical session. Secondary objective is to evaluate the Perioperative events between three surgical modalities in terms of Intra operative events; Estimated Blood Loss (EBL), rate of blood transfusion, Procedure duration and Post-operative events; Hospital Length of Stay, rate of post-operative complications and duration of needed Helmet therapy. Methods and Material The following electronic databases were searched from 2015 to 2019: PubMed, google scholar search engine. Cochrane database of systematic reviews, EMBASE for comparative studies between minimal invasive and open cranial vault remodelling techniques with different types of synostosis. Studies that were eligible if they contain the target keywords in title or abstract, addressing the age group up to 36 months with diagnosis of non- syndromic craniosynostosis by a plastic surgeon or neurosurgeon with or without confirmatory 3D skull reconstruction CT imaging. Follow-up outcomes were measured at 12 months or more. Exclusion criteria included studies lacking of quantitative comparison between open surgery and endoscopic assisted surgery, inclusion of patients with syndromic Craniosynostosis and editorials, abstracts and case reports. Results A total of 385 studies screened for eligibility, seven retrospective cohort studies were included in our systematic review for analysis of population demographics and management outcome with commenting of cosmetic outcome significance in comparison of different surgical modalities. Overall study population reaches 440 patients with different synostosis deformities with average age at surgery ranging from 2 to 6 months for endoscopic groups and 5 to 14 months for open surgery groups with average follow up duration reached 12 months. Analysis showed comparable postoperative cosmetic results between both techniques regardless type of synostosis with better perioperative outcomes such as less blood loss, shorter operations, shorter hospital stays and lower incidence of complications in minimal invasive and endoscopic assisted procedures groups. Conclusions We conclude that Minimal invasive approaches and especially endoscopic assisted craniotomies is a promising surgical option in craniosynostosis management. Regardless type of synostosis deformity, current literature comparing endoscopic and open CVR repair showed no statistical significant difference in craniometric analysis of cosmetic post-operative outcomes of both techniques. With improved perioperative outcomes, endoscopic assisted surgeries could be preferred for management team ideally for cases before 6 months age. Large population prospective studies and clinical trials are recommended for more high level evidence data for studying craniosynostosis management options for proper surgical decision making.

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Effects of Preoperative Iodine Administration on Thyroidectomy for Hyperthyroidism: A Systematic Review and Meta-analysis

Otolaryngology ◽

10.1177/0194599819829052 ◽

2019 ◽

Vol 160 (6) ◽

pp. 993-1002 ◽

Cited By ~ 1

Author(s):

Chung-Hsin Tsai ◽

Po-Sheng Yang ◽

Jie-Jen Lee ◽

Tsang-Pai Liu ◽

Chi-Yu Kuo ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Loss ◽

Operative Time ◽

Meta Analysis ◽

Thyroid Volume ◽

Vocal Cord Palsy ◽

Significant Heterogeneity ◽

Intraoperative Blood Loss ◽

Significant Difference ◽

And Control

Objective The current guidelines recommend that potassium iodide be given in the immediate preoperative period for patients with Graves’ disease who are undergoing thyroidectomy. Nonetheless, the evidence behind this recommendation is tenuous. The purpose of this study is to clarify the benefits of preoperative iodine administration from published comparative studies. Data Sources We searched PubMed, Embase, Cochrane, and CINAHL from 1980 to June 2018. Review Methods Studies were included that compared preoperative iodine administration and no premedication before thyroidectomy. For the meta-analysis, studies were pooled with the random-effects model. Results A total of 510 patients were divided into the iodine (n = 223) and control (n = 287) groups from 9 selected studies. Preoperative iodine administration was significantly associated with decreased thyroid vascularity and intraoperative blood loss. Significant heterogeneity was present among studies. We found no significant difference in thyroid volume or operative time. Furthermore, the meta-analysis showed no difference in the risk of postoperative complications, including vocal cord palsy, hypoparathyroidism/hypocalcemia, and hemorrhage or hematoma after thyroidectomy. Conclusion Preoperative iodine administration decreases thyroid vascularity and intraoperative blood loss. Nonetheless, it does not translate to more clinically meaningful differences in terms of operative time and postoperative complications.

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Introduction of gasless laparoscopic surgery as a minimally invasive procedure for endometrial cancer and its usefulness from the viewpoint of the learning curve

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02453-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Hiroe Ito ◽

Tetsuya Moritake ◽

Fumitoshi Terauchi ◽

Keiichi Isaka

Keyword(s):

Endometrial Cancer ◽

Laparoscopic Surgery ◽

Blood Loss ◽

Learning Curve ◽

Hospital Stay ◽

Open Surgery ◽

Operative Time ◽

Perioperative Complications ◽

Survival Rates ◽

Significant Difference

Abstract Background We investigated the usefulness of gasless laparoscopic surgery (GLS) using a subcutaneous abdominal wall lifting method for endometrial cancer. Methods We studied 105 patients with early endometrial cancer who underwent GLS (55) or open surgery (50). A uterine manipulator was used in all GLS cases. We compared operative time, blood loss, number of lymph nodes removed, hospital stay, perioperative complications, cases converted to laparotomy, and recurrence and survival rates. We also studied the learning curve and proficiency of GLS. Results The GLS group had significantly longer operative time (265 vs. 191 min), reduced blood loss (184 vs. 425 mL), shorter hospital stay (9.9 vs. 17.6 days), and fewer postoperative complications (1.8 vs. 12.0%) than the open group. No case was converted to laparotomy. Disease-free and overall survival rates at 4 years postoperatively (GLS vs. open groups) were 98.0 versus 97.8 and 100 versus 95.7%, respectively, and there was no significant difference between the groups. Regarding the learning curve for GLS, two different phases were observed in approximately 10 cases. Operator 2, who was not accustomed to laparoscopic surgery, showed a significant reduction in operative time in the later phase 2. Conclusions GLS for endometrial cancer results in less bleeding, shorter hospital stay, and fewer complications than open surgery. Recurrence and survival rates were not significantly different from those of open surgery. This technique may be introduced in a short time for operators who are skilled at open surgery but not used to laparoscopic surgery.

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A systematic review and meta-analysis of endoscopic versus open treatment of craniosynostosis. Part 1: the sagittal suture

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.4.peds17729 ◽

2018 ◽

Vol 22 (4) ◽

pp. 352-360 ◽

Cited By ~ 12

Author(s):

Han Yan ◽

Taylor J. Abel ◽

Naif M. Alotaibi ◽

Melanie Anderson ◽

Toba N. Niazi ◽

...

Keyword(s):

Systematic Review ◽

Length Of Stay ◽

Blood Loss ◽

Open Surgery ◽

Meta Analysis ◽

Operating Time ◽

Transfusion Rate ◽

Endoscopic Procedures ◽

Estimated Blood Loss ◽

Cosmetic Outcomes

OBJECTIVEIn this systematic review and meta-analysis the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of sagittal craniosynostosis, focusing on the outcomes of blood loss, transfusion rate, length of stay, operating time, complication rate, cost, and cosmetic outcome.METHODSA literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 electronic databases (MEDLINE, EMBASE, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to August 2017. The quality of methodology and bias risk were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Effect estimates between groups were calculated as standardized mean differences with 95% CIs. Random and fixed effects models were used to estimate the overall effect.RESULTSOf 316 screened records, 10 met the inclusion criteria, of which 3 were included in the meta-analysis. These studies reported on 303 patients treated endoscopically and 385 patients treated with open surgery. Endoscopic surgery was associated with lower estimated blood loss (p < 0.001), shorter length of stay (p < 0.001), and shorter operating time (p < 0.001). From the literature review of the 10 studies, transfusion rates for endoscopic procedures were consistently lower, with significant differences in 4 of 6 studies; the cost was lower, with differences ranging from $11,603 to $31,744 in 3 of 3 studies; and the cosmetic outcomes were equivocal (p > 0.05) in 3 of 3 studies. Finally, endoscopic techniques demonstrated complication rates similar to or lower than those of open surgery in 8 of 8 studies.CONCLUSIONSEndoscopic procedures are associated with lower estimated blood loss, operating time, and days in hospital. Future long-term prospective registries may establish advantages with respect to complications and cost, with equivalent cosmetic outcomes. Larger studies evaluating patient- or parent-reported satisfaction and optimal timing of intervention as well as heterogeneity in outcomes are indicated.

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Myth And Facts About The Evolving Role of Laparoscopic Splenectomy In Isolated High Grades Splenic Injuries In Hemodynamically Stable Patients With Blunt Abdominal Trauma. Randomized Controlled Trial.

10.21203/rs.3.rs-558748/v1 ◽

2021 ◽

Author(s):

Tamer.A. A.M. Habeeb ◽

Gamal Osman ◽

Amr Ibrahim ◽

Mohamed Riad ◽

Abd-Elrahman M. Metwalli ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Loss ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Laparoscopic Splenectomy ◽

Splenic Injury ◽

Laparoscopic Group ◽

Open Group ◽

High Grade ◽

Significant Difference

Abstract Background: Spleen is the most common intra-abdominal organ injury in blunt abdominal trauma. Splenectomy (open or laparoscopic) is the role in treatment of severe injuries of spleen or after failure of conservative treatment.Aim of the work: Compare the outcomes between open versus laparoscopic in high grade splenic injuries.Methods: This study includes 70 patients with various grades of splenic injuries in abdominal trauma. The patients were 15 years and older. They were categorized into two groups: open splenectomy group (35 patients) and laparoscopic splenectomy group (35 patients). The study was performed from January, 2012 to July 2017. Variables included demographics data, splenic injury graded by computerized tomography, duration of operation (in minutes), intra-operative blood loss (in ml), and intraoperative blood transfusion, length of hospital stay (in days), complications and mortality.Results: There was no significant difference or association between groups as regard age, sex and causes of splenic injury (p=0.374, 0.41, 0.38).Most cases were under 35 years old male patients exposed to motor car accidents. As regard intraoperative data, no statistically significant difference between both groups except for blood loss and transfusion that were statistically significant to the open group (p=0.039*).In the laparoscopic group, operational time was longer than open but no statistically significant (p=0.11).as regard conversion, we found that 14% of laparoscopic group (5 cases) had conversion. Most cases operated by laparoscopic approach were in grade III, IV with no cases tried in grade V (p=0.06). No statistically significant difference between both groups as regard postoperative variables except Pain (p=0.0003), and hospital stay(p=0.00) that were significantly longer among open group.The immediate postoperative complications showed that Wound infection, Missed injuries, pancreatic fistula and ileus were significantly higher among open group (p=0.00, 0.006, 0.02, 0.0004).The delayed postoperative complications where Incisional hernia (p=0.001) and Adhesive intestinal obstruction (p=0.00) were significantly associated with open group.Conclusion: In high-grade splenic injuries patients, this study found that laparoscopic splenectomy is safe.

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The effectiveness and safety of D2 plus para-aortic lymphadenectomy for resectable gastric cancer: a systematic review and meta-analysis

10.21203/rs.2.21493/v2 ◽

2020 ◽

Author(s):

Shi-Hui Zou ◽

Xi Zhong ◽

Jia-Le Zhang ◽

Bao-Jun Huang ◽

Hui-Mian Xu ◽

...

Keyword(s):

Gastric Cancer ◽

Systematic Review ◽

Lymph Node ◽

Postoperative Complications ◽

Malignant Tumors ◽

Meta Analysis ◽

Perioperative Outcomes ◽

Cochrane Library ◽

Term Survival ◽

Significant Difference

Abstract Background: Gastric cancer (GC) is among the malignant tumors of highest morbidity and mortality in the world, and has a profile of high lymph node metastasis rate. Lymph node clearance is a critical part of gastric cancer surgery, however, the extent of lymph node clearance, for example, whether to perform abdominal aortic lymph node dissection, remains considerably controversial. In this study, we performed a systematic review and meta-analysis to assess the effects of D2 plus para-aortic lymphadenectomy (PALD) on survival and postoperative complications in patients with GC.Methods: An electronic search was conducted through PubMed, Embase and cochrane library. The Q test and I2 were used to assess heterogeneity. The publication bias was evaluated via funnel plots. All statistical analyses were performed using STATA 14.0 (STATA, College Station, TX).Results: 908 studies were retrieved via literature search and eight studies were finally included. There was no significant difference between D2 and D2+PALD in the 5-year survival rate after surgery (HR: 1.00, 95% CI: 0.97-1.03, P = 0.897; I2 = 64.9%). Besides, the 30-day mortality (RR: 1.17, 95% CI: 0.66-2.10, P = 0.590; I2 = 0.0%) and the overall risk of postoperative complications (RR: 1.15, 95% CI: 0.83-1.59, P = 0.411; I2 = 35.5%) were comparable between D2 and D2+PALD.Conclusion: Based on current literature body, compared with D2, D2+PALD does not prevail in terms of long-term survival or perioperative outcomes.

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Patient-Specific or Conventional Instrumentations: A Meta-analysis of Randomized Controlled Trials

BioMed Research International ◽

10.1155/2020/2164371 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

Yipeng Lin ◽

Wufeng Cai ◽

Baoyun Xu ◽

Jian Li ◽

Yuan Yang ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Randomized Controlled Trials ◽

Operative Time ◽

Mechanical Axis ◽

Meta Analysis ◽

Patient Specific ◽

Controlled Trials ◽

Randomized Controlled ◽

Significant Difference

Objective. To conduct a meta-analysis of randomized controlled trials (RCTs) to compare knee arthroplasty with patient-specific instrumentation (PSI) with the conventional instrumentation (CI). Methods. RCTs were selected in PubMed and Embase from 2012 to 2018. Key data extracted included malalignment of mechanical axis, blood loss, surgical time, Oxford Knee Score (OKS), Knee Society Score (KSS), length of stay, and complications. Subgroup analysis was also performed regarding different PSI systems and different image processing methods. Results. 29 RCTs with 2487 knees were eligible for the meta-analysis. Results showed that PSI did not improve the alignment of the mechanical axis compared with CI, but MRI-based PSI and Visionaire-specific PSI decrease the risk of malalignment significantly (P=0.04 and P=0.003, respectively). PSI reduced operative time (P=0.03) and blood loss (P=0.002) and improve the KSS (P=0.02) compared with CI, but for CT-based PSI, the difference of operative time becomes insignificant. PSI showed no significant difference with CI regarding risk of complication, length of stay in hospital, and functional outcomes of OKS. Conclusion. PSI reduced the blood loss and improved KSS. MRI-based PSI reduced operative time and risk of malalignment of mechanical axis compared with CT-based PSI. Moreover, Visionaire-specific PSI achieves better alignment result of the mechanical axis than other systems.

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Vagal Nerve Stimulator Placement by a Vascular Surgeon

The American Surgeon ◽

10.1177/0003134820943553 ◽

2020 ◽

pp. 000313482094355

Author(s):

Amy K. Wise ◽

Adam C. Hicks ◽

Abindra Sigdel

Keyword(s):

Postoperative Complications ◽

Blood Loss ◽

Operative Time ◽

Seizure Activity ◽

Vagal Nerve ◽

Anatomical Location ◽

Nerve Stimulator ◽

Vascular Surgeon ◽

Vagal Nerve Stimulator ◽

Significant Difference

Background Refractory seizure activity represents a difficult problem for both patients and practitioners. Implantation of the vagal nerve stimulator has been posited as an effective treatment for refractory seizure activity. These devices are inserted by placing leads into the carotid sheath along the vagus nerve. We evaluated a vascular surgeon’s experience placing vagal nerve stimulators. Methods We examined all patients treated with placement of vagal nerve stimulator by a single surgeon from October 2016 to October 2018. Data collected included demographics, medical and surgical history, intraoperative variables, and complications. Results Thirty-four patients underwent placement of a vagal nerve stimulator. About 29.4% had a previous vagal nerve stimulator placed on the ipsilateral side. Intraoperative bradycardia was seen in 1 patient. Postoperative complications were identified in 5 patients, all of which were transient dysphagia or changes in voice quality which did not require intervention. There was no significant difference between patients with the previous operation and those without for developing postoperative complications ( P = .138). Average blood loss was higher in patients who had undergone previous stimulator placement than those who had not ( P = .0223), and the operative time was longer ( P ≤ .0001). Discussion Given the anatomical location of placement, vascular surgeons may be called upon to place these devices. In our single surgeon series, we found that the placement was safe, with minimal complications. Intraoperatively, this case appears to be more difficult (with higher blood loss and longer operative time) in patients who have had previous device placement, but this does not appear to lead to increased complications.

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Comparison of anterior, posterior, and anterior combined with posterior surgical treatment of thoracic and lumbar spinal tuberculosis: a systematic review

Journal of International Medical Research ◽

10.1177/0300060519830827 ◽

2019 ◽

Vol 48 (2) ◽

pp. 030006051983082

Author(s):

Zhouliang Bian ◽

Yiding Gui ◽

Fan Feng ◽

Hongxing Shen ◽

Lifeng Lao

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Posterior Approach ◽

Operative Time ◽

Spinal Tuberculosis ◽

Surgical Approaches ◽

Significant Difference ◽

The Difference ◽

Lumbar Spinal ◽

Anterior Posterior

Background This study was performed to compare different surgical approaches in the treatment of spinal tuberculosis. Methods We conducted a literature search to identify and analyze papers published from January 1966 to April 2018 relevant to comparison of the anterior, posterior, and anterior combined with posterior approaches in the treatment of spinal tuberculosis of the thoracic and lumbar regions. Results Twenty-five studies involving 2295 patients were identified in this systematic review. The operative time was significantly longer in the anterior combined with posterior approach than in the other two approaches. Blood loss was significantly greater in the anterior combined with posterior approach (1125.0 ± 275.5 mL) than in the posterior approach (710.4 ± 192.4 mL). The difference in correction of the kyphosis angle among the three procedures was not significant. The overall surgical and transthoracic complications were significantly lower in the posterior approach. The clinical outcome of all patients improved, but there was no significant difference among the three procedures. Conclusions Blood loss, overall surgical and transthoracic complications, and the operative time are different among the three approaches. Therefore, different factors must be carefully assessed in deciding among the three procedures.

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Peri-Operative Outcomes after Open and Robot-Assisted Radical Cystectomy by Using an Advanced Bipolar Seal and Cut Technology (Caiman®): A Prospective, Comparative, and Multi-Institutional Study

Current Urology ◽

10.1159/000489421 ◽

2018 ◽

Vol 12 (2) ◽

pp. 64-69 ◽

Cited By ~ 4

Author(s):

Marco Borghesi ◽

Riccardo Schiavina ◽

Alessandro Antonelli ◽

Carlo Buizza ◽

Antonio Celia ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Radical Cystectomy ◽

Operative Time ◽

Length Of Hospital Stay ◽

Transfusion Rate ◽

Robot Assisted ◽

Operative Outcomes ◽

Estimated Blood Loss ◽

Significant Difference

Objective: To report and compare the peri-operative outcomes of patients undergoing open (ORC) and robotic-assisted radical cystectomy (RARC) for bladder cancer performed with a radiofrequency seal and cut device (Caiman®). Materials and Methods: Data of patients undergoing ORC or RARC between January 2015 and March 2016 at 6 Italian institutions were prospectively recorded and analyzed. Thirty-and 90-day complications were stratified according to the Martin's criteria and graded according to the Clavien-Dindo classification. Data on operative time, blood loss, transfusion rate, complications, and length of stay were evaluated and compared between the ORC and RARC groups. Results: Thirty-three (66%) and 17 (34%) patients were treated with ORC and RARC, respectively. The median age was 72 (64-78) years. Overall operative time was longer in RARC compared to ORC (389 ± 80.1 vs. 242 ± 62.2 min, p < 0.001), while the estimated blood loss during cystectomy was higher after ORC (370 ± 126.8 vs. 243.3 ± 201.6 ml, p = 0.03). The transfusion rate was significantly higher in the ORC compared to RARC (24.2 vs. 5.9%, p = 0.04). Eight (19%) and 7 (16.7%) patients experienced 30- and 90-day post-operative complications, with no significant difference between ORC and RARC. Length of stay was significantly shorter in RARC group (median 7 vs. 14 days, p < 0.001). Conclusion: Open and robot-assisted procedures were safely performed by using a new advanced bipolar seal and cut technology (Caiman®). RARC demonstrated to be superior to ORC in terms of bleeding, transfusion rates and length of hospital stay, despite longer operative time.

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