Early outcomes of robotic versus laparoscopic splenectomy in pediatric population: a systematic review and meta-analysis

摘要

BACKGROUND: Laparoscopic splenectomy (LS) is currently well-established as a standard technique for splenectomy. Robotic splenectomy (RS) is being introduced as a new minimally invasive alternative. The current study aims to directly compare RS and LS specifically in the pediatric population undergoing splenectomy for non-traumatic indications. METHODS: We performed a systematic search in four databases: PubMed, Web of Science, Scopus and Cochrane CENTRAL in November 2024. We included studies that compared outcomes of RS and LS in pediatric patients. We extracted the amount of blood loss, operation time, length of hospital stay, the number of patients who needed blood transfusion or were converted to open approach and post-operative complications. Finally, RevMan software was adopted for meta-analysis. RESULTS: Six retrospective studies met our eligibility criteria and were included in the current systematic review and meta-analysis with a total of 248 patients, of which 123 and 125 children underwent RS and LS respectively. Blood loss was significantly lower in RS group (MD = -56.95, P = 0.01). Operation time, hospital stay, the need for blood transfusion and post-operative complications showed no significant difference between both RS and LS groups. Despite the overall good quality of the included studies, the GRADE quality of evidence was considered very low due to the observational nature of the included studies, small sample sizes and high variability between outcomes of different studies. CONCLUSION: Our study guides the existing literature towards a possible non-inferior status of robotic splenectomy compared to the well-established laparoscopic splenectomy in most clinical outcomes. Blood loss was significantly lower in children who underwent robotic splenectomy, but small sample size limits generatability of such finding. The challenge of higher costs of robotic splenectomy needs to be addressed in well-designed cost-effectiveness studies.