Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2023; 15(7): 1501-1511
Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1501
Spleen-preserving distal pancreatectomy from multi-port to reduced-port surgery approach
Ching-Lung Hsieh, Tung-Sheng Tsai, Cheng-Ming Peng, Teng-Chieh Cheng, Yi-Jui Liu
Ching-Lung Hsieh, Department of Computer Science and Information Engineering, Feng Chia University, Taichung 40724, Taiwan
Ching-Lung Hsieh, Cheng-Ming Peng, Department of Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
Tung-Sheng Tsai, PhD Program of Electrical and Communications Engineering, Feng Chia University, Taichung 40724, Taiwan
Cheng-Ming Peng, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
Teng-Chieh Cheng, Da Vinci Minimally Invasive Surgery Center, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
Yi-Jui Liu, Department of Automatic Control Engineering, Feng Chia University, Taichung 407, Taiwan
Author contributions: Hsieh CL, Peng CM, and Liu YJ designed the research study; Tsai TS and Cheng TC performed the research; Hsieh CL and Liu YJ analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Supported by Chung Shan Medical University, No. 15I42440; Feng Chia University/Chung Shan Medical University, No. FCU/CSMU104-001; and Taiwan National Science and Technology Council, No. 111-2314-B-035-001-MY3 and No. 110-2221-E-035-016.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Jui Liu, PhD, Professor, Department of Automatic Control Engineering, Feng Chia University, No. 100 Wenhwa Road, Seatwen, Taichung 407, Taiwan. erliu@fcu.edu.tw
Received: February 4, 2023
Peer-review started: February 4, 2023
First decision: March 14, 2023
Revised: March 28, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: July 27, 2023
Abstract
BACKGROUND

Minimally invasive pancreatic surgery via the multi-port approach has become a primary surgical method for distal pancreatectomy (DP) due to its advantages of lower wound pain and superior cosmetic results. Some studies have applied reduced-port techniques for DP in an attempt to enhance cosmetic outcomes due to the minimally invasive effects. Numerous recent review studies have compared multi-port laparoscopic DP (LDP) and multi-port robotic DP (RDP); most of these studies concluded multi-port RDP is more beneficial than multi-port LDP for spleen preservation. However, there have been no comprehensive reviews of the value of reduced-port LDP and reduced-port RDP.

AIM

To search for and review the studies on spleen preservation and the clinical outcomes of minimally invasive DP that compared reduced-port DP surgery with multi-port DP surgery.

METHODS

The PubMed medical database was searched for articles published between 2013 and 2022. The search terms were implemented using the following Boolean search algorithm: (“distal pancreatectomy” OR “left pancreatectomy” OR “peripheral pancreatic resection”) AND (“reduced-port” OR “single-site” OR “single-port” OR “dual-incision” OR “single-incision”) AND (“spleen-preserving” OR “spleen preservation” OR “splenic preservation”). A literature review was conducted to identify studies that compared the perioperative outcomes of reduced-port LDP and reduced-port RDP.

RESULTS

Fifteen articles published in the period from 2013 to 2022 were retrieved using three groups of search terms. Two studies were added after manually searching the related papers. Finally, 10 papers were selected after removing case reports (n = 3), non-English language papers (n = 1), technique papers (n = 1), reviews (n = 1), and animal studies (n = 1). The common items were defined as items reported in more than five papers, and data on these common items were extracted from all papers. The ten studies included a total of 337 patients (females/males: 231/106) who underwent DP. In total, 166 patients (females/males, 106/60) received multi-port LDP, 126 (females/males, 90/36) received reduced-port LDP, and 45 (females/males, 35/10) received reduced-port RDP.

CONCLUSION

Reduced-port RDP leads to a lower intraoperative blood loss, a lower postoperative pancreatic fistula rate, and shorter hospital stay and follow-up duration, but has a lower spleen preservation rate.

Keywords: Minimally invasive surgery, Robotic distal pancreatectomy, Laparoscopic distal pancreatectomy, Spleen preservation, Reduced-port, Multi-port

Core Tip: In contrast to recent review articles, this mini-review article is the first report to summarize all of the available evidence on spleen-preserving surgery with reduced-port robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP). Previous review articles only compared multi-port LDP with multi-port RDP. Our results show that conventional multi-port LDP has a shorter operating time than reduced-port LDP and reduced-port RDP. However, the reduced-port techniques result in less intraoperative blood loss; reduced-port RDP has the lowest blood loss. Moreover, reduced-port RDP leads to a lower postoperative pancreatic fistula rate and shorter hospital stay and follow-up duration, but a lower spleen preservation rate.