Robotic-Assisted vs. Laparoscopic Splenectomy in Children: A Systematic Review and Up-to-Date Meta-Analysis

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robotic splenectomy offers potential advantages in precision and personalized surgical planning.
• Its clinical superiority over laparoscopic surgery in pediatric patients is uncertain due to limited evidence.

Purpose of the Study:

• To systematically review and meta-analyze the available evidence on robotic splenectomy in pediatric patients.
• To compare the safety and efficacy of robotic versus laparoscopic splenectomy.

Main Methods:

• Systematic review and meta-analysis of studies on pediatric robotic splenectomies.
• Searched PubMed, CINAHL, Web of Science, and EMBASE databases.
• Assessed risk of bias and certainty of evidence using ROBINS-I and GRADE frameworks.

Main Results:

• Included 272 pediatric patients from 16 studies; 5 in meta-analysis.
• No significant differences in operative time, blood loss, or complications.
• Robotic approach favored in effect estimates; reduced hospitalization days (p=0.01) but marginally significant after adjustment.
• Substantial heterogeneity and very low certainty of evidence.

Conclusions:

• Robotic-assisted splenectomy is feasible and safe in selected pediatric cases.
• Low study numbers, retrospective designs, and heterogeneity limit firm conclusions.
• High-quality prospective studies are required to determine clinical benefits.