Pediatric Mini-Invasive Splenectomy Comparing Laparoscopy With or Without Robotic Approach: A Single-Center Study

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Surgical Technology

Background:

• Pediatric robotic surgery programs are expanding, yet the role of robotic assisted splenectomy (RAS) remains debated.
• Evaluating the feasibility and safety of RAS in children is crucial for its integration into surgical practice.
• Comparing RAS outcomes to traditional laparoscopic splenectomy (LAS) provides essential data for clinical decision-making.

Purpose of the Study:

• To assess the feasibility and safety of robotic assisted splenectomy (RAS) in pediatric patients.
• To compare the outcomes of RAS with those of laparoscopic splenectomy (LAS) in children.
• To analyze the impact of the learning curve on RAS outcomes in a single surgeon's experience.

Main Methods:

• A retrospective study of 41 pediatric splenectomy cases (26 LAS, 15 RAS) conducted between 2011 and 2020.
• Utilized the minimally invasive splenectomy score to quantify surgical difficulty.
• Collected data included operative time, blood transfusion requirements, complications, analgesic use, and hospital stay duration.

Main Results:

• Robotic assisted splenectomy (RAS) had a significantly longer operative time (223 min) compared to laparoscopic splenectomy (LAS) (97 min) (P < .001).
• Hospital stay was comparable between RAS (5 days) and LAS (6.5 days) (P = .055), with no significant difference in analgesic use (P = .29).
• Both procedures demonstrated comparable safety profiles, even in cases of difficult splenectomies, with improved RAS outcomes noted as the surgeon's experience grew.

Conclusions:

• Robotic assisted splenectomy (RAS) is a safe procedure in pediatric surgery, aligning with existing literature.
• However, RAS does not offer significant advantages over laparoscopic splenectomy (LAS) due to increased operative time and costs.
• This study's extensive 9-year experience with broad indications provides valuable insights into pediatric RAS versus LAS.