Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy

Aziret, Mehmet; Koyun, Bülent; Karaman, Kerem; Sunu, Cenk; Karacan, Alper; Öter, Volkan; Çelebi, Fehmi; Ercan, Metin; Bostancı, Erdal Birol

doi:10.5578/turkjsurg.4535

Cited by 7 publications

(5 citation statements)

References 25 publications

(43 reference statements)

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“…We have previously demonstrated that the lateral approach to laparoscopic splenectomy is associated with lower need for blood transfusion, lower volume of blood loss, conversion to open procedure, post-operative complications and need for reoperation than the anterior approach. 26 Such approach seems to be the most appropriate approach in robotic splenectomy as well although comparative evidence of lateral and anterior approach in robotic splenectomy does not exist.…”

Section: Discussionmentioning

confidence: 99%

Robotic vs. Laparoscopic Splenectomy in Management of Non-traumatic Splenic Pathologies: A Systematic Review and Meta-Analysis

Bhattacharya

Phelan

Fisher

et al. 2021

The American Surgeon

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We aimed to evaluate comparative outcomes of robotic and laparoscopic splenectomy in patients with non-traumatic splenic pathologies. A systematic search of electronic databases and bibliographic reference lists were conducted, and a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in electronic databases were applied. Intraoperative and post-operative complications, wound infection, haematoma, conversion to open procedure, return to theatre, volume of blood loss, procedure time and length of hospital stay were the evaluated outcome parameters. We identified 8 comparative studies reporting a total of 560 patients comparing outcomes of robotic ( n = 202) and laparoscopic ( n = 258) splenectomies. The robotic approach was associated with significantly lower volume of blood loss (MD: −82.53 mls, 95% CI −161.91 to −3.16, P = .04) than the laparoscopic approach. There was no significant difference in intraoperative complications (OR: 0.68, 95% CI .21-2.01, P = .51), post-operative complications (OR: .91, 95% CI .40-2.06, P = .82), wound infection (RD: -.01, 95% CI -.04-.03, P = .78), haematoma (OR: 0.40, 95% CI .04-4.03, P = .44), conversion to open (OR: 0.63; 95% CI, .24-1.70, P = .36), return to theatre (RD: −.04, 95% CI -.09-.02, P = .16), procedure time (MD: 3.63; 95% CI -16.99-24.25, P = .73) and length of hospital stay (MD: −.21; 95% CI -1.17 - .75, P = .67) between 2 groups. In conclusion, robotic and laparoscopic splenectomies seem to have comparable perioperative outcomes with similar rate of conversion to an open procedure, procedure time and length of hospital stay. The former may potentially reduce the volume of intraoperative blood loss. Future higher level research is required to evaluate the cost-effectiveness and clinical outcomes

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Section: Discussionmentioning

confidence: 99%

Robotic vs. Laparoscopic Splenectomy in Management of Non-traumatic Splenic Pathologies: A Systematic Review and Meta-Analysis

Bhattacharya

Phelan

Fisher

et al. 2021

The American Surgeon

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“…3 ). Indirect splenic hilum dissection method was used, as described by Aziret et al [ 18 ]. A 5-mm bipolar vessel sealer was used for dissection and ligation of the spleen (splenocolic, splenophrenic and splenogastric).…”

Section: Resultsmentioning

confidence: 99%

“…Open splenectomy or minimally invasive splenectomy are both options for surgical treatment [ [62] , [63] , [64] , [65] , [66] , [67] , [68] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] ]. In recent years, minimally invasive surgery such as robotic or laparoscopic splenectomy has become more popular due to a shorter hospital stay, less postoperative abdominal pain, and an early return to normal activity [ 18 , [63] , [64] , [65] , 78 ]. After total splenectomy, no evidence of recurrence was reported in the follow-up period (median follow-up:12 months (0–166)).…”

Section: Discussionmentioning

confidence: 99%

“…A total of 230 SANT patients undergoing laparoscopic, open splenectomy or biopsy between 2004 and April 2020 were reported on in English language literature [ [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] ]. Patient information was only retrieved from English language medical databases with full-texts, using Google Scholar, PubMed, Scopus and Research-gate.…”

Section: Systematic Literature Reviewmentioning

confidence: 99%

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Sclerosing angiomatoid nodular transformation presenting with thrombocytopenia after laparoscopic splenectomy - Case report and systematic review of 230 patients

Aziret

Yılmaz

Kalpakci

et al. 2020

Annals of Medicine and Surgery

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Background Sclerosing angiomatoid vascular transformation (SANT) is a rare vascular disease of the spleen, which is difficult to diagnose due to its pre-intervention appearance of malignancy. Case Report: An 85-year-old male was transferred to our clinic for thrombocytopenia and splenic mass. A contrast enhanced abdominal CT and MRI showed nodular lesions, the largest 50mm in diameter, and several areas of heterogeneous contrast field involvement in the spleen parenchyma. Laparoscopic splenectomy was performed with normal range of platelet level. The patient's postoperative course was uneventful and he was discharged on the 6th postoperative day. Histopathology revealed SANT. The patient is now in the 18 th month of remission with platelet levels within normal range and with no recurrence. Results Between 2004 and April 2020, a total of 230 SANT patients who underwent laparoscopic or open splenectomy or biopsy were reported in the literature. Most patients were female (52.1%), and the median age was 46 years (9 weeks-85 years). Most patients were asymptomatic (56%). Open splenectomy was performed on 166 patients (72.1%),laparoscopic splenectomy on 35 patients (15.2%) and laparoscopic partial splenectomy on 15 patients (6.5%). The median operation time and spleen weight were 143 minutes (88-213) and 260gr (68-2,720), respectively. Median follow-up time was 12 months (0-166). No recurrence was seen in patients undergoing total splenectomy. Conclusion SANT is an unusual disease of the spleen. In the light of this systematic review, a minimally invasive method for total or partial splenectomy,specifically laparoscopy, can be preferred as the treatment of choice.

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“…Intraoperative bleeding is the most common complication affecting the efficacy and prognosis of surgery and is a crucial factor. it is difficult to control bleeding in a timely fashion once the intraoperative bleeding occurs during laparoscopic surgery ( 19 , 23 , 24 ). In the present study, 14 of 120 patients experienced uncontrollable bleeding during operation, eleven cases experienced bleeding from the splenic vein, and another three patients experienced short gastric vessels.…”

Section: Discussionmentioning

confidence: 99%

Single-incision laparoscopic splenectomy in children with massive splenomegaly: A prospective, monocentric pilot study

et al. 2023

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BackgroundSingle-incision laparoscopic splenectomy (SILS) remains a challenging procedure because of the technical difficulty. In this prospective study, we aimed to evaluate the efficacy and safety of SILS in children with massive splenomegaly.MethodsPediatric patients with massive splenomegaly were recruited for SILS in a university-affiliated hospital. The data on patient demographics, clinical features, operative variables, and perioperative outcomes were collected prospectively and analyzed. According to the different surgical instruments, the patients were randomly assigned into two groups: the SILS with straight surgical instrument (SILS-S) group and the SILS with curved surgical instrument (SILS-C) group. A two-group comparative analysis was conducted using perioperative data from the different surgical instrumentation systems.ResultsA total of 120 patients were included, of which 103 patients (success group, 85.83%) had complete SILS, the other 17 (failure group, 14.17%) patients were converted to open (n = 4, 3.33%) or multi-incision laparoscopic surgery (n = 13, 10.83%). The major cause for surgical failure is uncontrollable bleeding (n = 14, 82.35%), and age, height, and weight were the risk factors for failure of SILS, but none of the parameters were independent risk factors. The blood loss in the success group was less than that in the failure group, but no significant differences in other operative and outcome indicators. For SILS, the mean (±SD) operative time was 188 (±48.70) minutes, the median intraoperative blood loss (min, max) was 20 (5, 290) ml, the mean (±SD) time of first anal exhaust was 23.9 (±7.73) hours, and the mean (±SD) postoperative hospital stay was 4.72 (±1.03) days. The median pain score was 3 on 1 day, and 1 on 3 days after the operation. Postoperative complications were identified in 8 (7.77%) cases. However, there were no peri-operative deaths in this series. The SILS-C group had a significantly shorter operation time than the SILS-S group (mean ± SD, 172 ± 44.21 vs. 205 ± 47.90 min). There were no significant differences between the two groups in other perioperative data (P < 0.05).ConclusionSILS is a safe and feasible treatment in pediatric patients with massive splenomegaly, and curved surgical instrumentation has contributed to developing surgical manipulation.

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Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy

Abstract: Öter V, et al. Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy.

Cited by 7 publications

References 25 publications

Robotic vs. Laparoscopic Splenectomy in Management of Non-traumatic Splenic Pathologies: A Systematic Review and Meta-Analysis

Robotic vs. Laparoscopic Splenectomy in Management of Non-traumatic Splenic Pathologies: A Systematic Review and Meta-Analysis

Sclerosing angiomatoid nodular transformation presenting with thrombocytopenia after laparoscopic splenectomy - Case report and systematic review of 230 patients

Single-incision laparoscopic splenectomy in children with massive splenomegaly: A prospective, monocentric pilot study

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