Superiority of Robotic Over Laparoscopic Spleen-Preserving Distal Pancreatectomy With Warshaw Procedure for Reducing the Incidence of Postoperative Splenic Infarction.

Yasuhiro Murata, Daisuke Noguchi, Takahiro Ito, Aoi Hayasaki, Yusuke Iizawa, Takehiro Fujii, Akihiro Tanemura, Naohisa Kuriyama, Masashi Kishiwada, Shugo Mizuno
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Abstract

Background: Minimally invasive spleen-preserving distal pancreatectomy with Warshaw procedure (MI-WP), has gained widespread recognition for the treatment of benign and low-grade malignant tumors of the pancreatic body and tail. However, the comparative advantages of the robotic Warshaw procedure (R-WP) over the laparoscopic Warshaw procedure (L-WP) remain uncertain. This study aimed to compare the surgical outcomes between R-WP and L-WP.

Materials and methods: Among the 146 cases of MI-DP conducted between October 2020 and December 2023 (L-DP:115, R-DP:31), 33 cases of MI-WP were subjected to analysis, comprising the R-WP group (n=10) and the L-WP group (n=23).

Results: R-WP successfully completed all procedures under a purely laparoscopic approach, whereas L-WP necessitated conversion to open surgery in 2 cases (8.7%). Despite the significantly prolonged operative time in R-WP compared with L-WP (R-WP vs. L-WP: 421vs. 300 min), there was no significant difference in estimated blood loss between the 2 groups (R-WP vs. L-WP: 19 vs. 20 mL). Although the rate of major complications did not significantly differ between the 2 groups, 2 cases (8.7%) of L-WP required reoperation, including splenectomy in 1 instance. Furthermore, the incidence of postoperative splenic infarction was significantly higher in L-WP than in R-WP (R- vs. L-WP:0 vs. 43.5%, P =0.015). The length of hospital stay after surgery did not exhibit a significant difference between the 2 groups (R-WP vs. L-WP: 11 vs. 12 d).

Discussion: R-WP demonstrated superiority to L-WP for reducing the incidence of postoperative splenic infarction, potentially contributing to enhancing the spleen preservation rate.

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在降低术后脾梗塞发生率方面,机器人保脾胰腺远端切除术与腹腔镜Warshaw手术相比更具优势。
背景:华肖微创保脾胰腺远端切除术(MI-WP)在治疗胰体和胰尾良性和低度恶性肿瘤方面已获得广泛认可。然而,机器人华肖手术(R-WP)与腹腔镜华肖手术(L-WP)的比较优势仍不确定。本研究旨在比较R-WP和L-WP的手术效果:在2020年10月至2023年12月期间进行的146例MI-DP(L-DP:115例,R-DP:31例)中,对33例MI-WP进行分析,包括R-WP组(10例)和L-WP组(23例):结果:R-WP组在纯腹腔镜方法下成功完成了所有手术,而L-WP组有2例(8.7%)必须转为开腹手术。尽管R-WP的手术时间明显长于L-WP(R-WP vs. L-WP:421分钟vs 300分钟),但两组的估计失血量并无明显差异(R-WP vs. L-WP:19毫升vs 20毫升)。虽然两组的主要并发症发生率没有明显差异,但有 2 例(8.7%)L-WP 患者需要再次手术,其中 1 例需要进行脾脏切除术。此外,L-WP术后脾梗死的发生率明显高于R-WP(R- vs. L-WP:0 vs. 43.5%,P=0.015)。两组术后住院时间无明显差异(R-WP vs. L-WP:11 d vs. 12 d):讨论:在降低术后脾梗死发生率方面,R-WP优于L-WP,这可能有助于提高脾脏保留率。
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来源期刊
CiteScore
2.00
自引率
10.00%
发文量
103
审稿时长
3-8 weeks
期刊介绍: Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.
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