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TÜRKÇE
Poster - 139
Comparative Outcomes of Robotic, Laparoscopic, and Open Splenectomy: A Systemic Review and Meta-Analysis From Pediatric Surgery Meta-Analysis Study Group (PESMA)
Duygu Gürel 1, Federica Pederiva 2, Mustafa Azizoğlu 3, Nitinkumar Borkar 4, Maria Escolino 5, Tahsin Onat Kamçı 6, Ayşe Parlak 7, Donatella Di Fabrizio 8, Esma Karadeniz Güngörmez 3, Holger Till 9, Ismael Elhalaby 10, Mehmet Hanifi Okur 11, Sameh Shehata 12, Ciro Esposito 5, Annika Mutanen 13
1 Istanbul Health Sciences University, Prof. Dr. Cemil Taşçıoğlu City Hospital, Department of Pediatric Surgery and Pediatric Urology
2 Pediatric Surgery Unit, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy
3 Basaksehir Cam and Sakura City Hospital Department of Pediatric Surgery, Istanbul, Turkey.
4 Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India
5 Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
6 Tatvan State Hospital, Department of Pediatric Surgery, Bitlis, Turkey
7 Uludag University, Department of Pediatric Surgery, Bursa, Turkey
8 Pediatric Surgery Unit, Salesi Children's Hospital, Ancona, Italy,
9 Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
10 Department of Pediatric Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
11 Balikesir University, Department of Pediatric Surgery, Balikesir, Turkey
12 Department of Pediatric Surgery, Alexandria University, Alexandria, Egypt
13 Department of Pediatric Surgery, The New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Aim:To compare clinical outcomes of robotic (RS), laparoscopic (LS), and open (OS) splenectomy in children.
Methods:A systematic review and meta-analysis were performed in accordance with the PRISMA guidelines. Relevant studies published during the last two decades and comparing RS, LS, or OS were systematically searched up to December 2025. Comparisons included RS versus LS and LS versus OS.
Results: Sixteen retrospective studies were included. Compared with OS, LS showed lower odds of overall complications (OR 0.64, 95% CI 0.37-1.09; p=0.09) and perioperative transfusion (OR 0.41, 95% CI 0.16-1.07; p=0.06), although these differences did not reach statistical significance. In the comparison between RS and LS, no significant differences were observed in overall complication rate (p=0.50), transfusion rate (p=0.26), conversion to open surgery (p=0.64), or lenght of hospital stay (p=0.11). Descriptive findings generally indicated shorter operative times with OS.
Conclusions: RS and LS demonstrated favorable outcomes in children. Compared with OS, LS showed a consistent trend toward lower overall complication and transfusion rates, although statistical significance was not reached. RS appeared feasible and safe, with comparable complication, transfusion, conversion, and length-of-stay outcomes when compared with LS. While OS may still offer shorter operative times, minimally invasive techniques represent effective alternatives with potential perioperative advantages.
Çocuklarda Robotik, Laparoskopik ve Açık Splenektomi Sonuçlarının Karşılaştırılması: Pediatrik Cerrahi Meta-Analiz Çalışma Grubu (PESMA) Sistematik Derleme ve Meta-Analiz
Duygu Gürel 1, Federica Pederiva 2, Mustafa Azizoğlu 3, Nitinkumar Borkar 4, Maria Escolino 5, Tahsin Onat Kamçı 6, Ayşe Parlak 7, Donatella Di Fabrizio 8, Esma Karadeniz Güngörmez 3, Holger Till 9, Ismael Elhalaby 10, Mehmet Hanifi Okur 11, Sameh Shehata 12, Ciro Esposito 5, Annika Mutanen 13
1 Istanbul Health Sciences University, Prof. Dr. Cemil Taşçıoğlu City Hospital, Department of Pediatric Surgery and Pediatric Urology
2 Pediatric Surgery Unit, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy
3 Basaksehir Cam and Sakura City Hospital Department of Pediatric Surgery, Istanbul, Turkey.
4 Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India
5 Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
6 Tatvan State Hospital, Department of Pediatric Surgery, Bitlis, Turkey
7 Uludag University, Department of Pediatric Surgery, Bursa, Turkey
8 Pediatric Surgery Unit, Salesi Children's Hospital, Ancona, Italy,
9 Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
10 Department of Pediatric Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
11 Balikesir University, Department of Pediatric Surgery, Balikesir, Turkey
12 Department of Pediatric Surgery, Alexandria University, Alexandria, Egypt
13 Department of Pediatric Surgery, The New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Amaç: Çocuklarda robotik (RS), laparoskopik (LS) ve açık (OS) splenektominin klinik sonuçlarını karşılaştırmak.
Yöntem: PRISMA kılavuzuna uygun olarak sistematik derleme ve meta-analiz gerçekleştirildi. Aralık 2025 tarihine kadar son iki dekadda yayınlanan ve RS, LS veya OS yöntemlerini karşılaştıran çalışmalar, sistematik olarak tarandı. Karşılaştırmalar RS ile LS ve LS ile OS arasında yapıldı.
Bulgular: Çalışmaya 16 retrospektif araştırma dahil edildi. OS ile karşılaştırıldığında LS, daha düşük genel komplikasyon olasılığı (OR 0,64, %95 GA 0,37–1,09; p=0,09) ve daha düşük perioperatif transfüzyon olasılığı (OR 0,41, %95 GA 0,16–1,07; p=0,06) ile ilişkiliydi; ancak istatistiksel olarak anlamlı bulunmadı. RS ile LS karşılaştırıldığında komplikasyon oranı (p=0,50), transfüzyon oranı (p=0,26), açık cerrahiye dönme oranı (p=0,64) ve hastanede kalış süresinde (p=0,11) anlamlı farklılık saptanmadı. Bulgular genel olarak açık splenektomi süresinin robotik ve laparoskopik yönteme göre daha kısa olduğunu gösterdi.
Sonuç: RS ve LS, çocuklarda olumlu sonuçlar göstermiştir. OS ile karşılaştırıldığında LS’de komplikasyon ve transfüzyon oranlarının daha düşük olma eğilimi gözlenmiş; ancak istatistiksel olarak anlamlı bulunmamıştır. RS’nin uygulanabilir ve güvenli olduğu; LS ile karşılaştırıldığında komplikasyon, transfüzyon, açık cerrahiye dönüşüm ve hastanede kalış süresi açısından benzer sonuçlar görülmüştür. OS daha kısa ameliyat süresi sağlayabilse de; minimal invaziv cerrahi yöntemler, potansiyel perioperatif avantajları sayesinde açık cerrahiye alternatif olarak görülmektedir.