Clinical efficacy of Da Vinci robotic assisted vagus nerve-preserving splenectomy and azygo-portal disconnection / 中华消化外科杂志

ABSTRACT

Objective:To investigate the clinical efficacy of Da Vinci robotic assisted vagus nerve-preserving splenectomy and azygoportal disconnection.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 10 cirrhotic portal hypertension patients with esophagogastric variceal bleeding and hypersplenism who were admitted to Clinical Medical College of Yangzhou University from February to May 2021 were collected. There were 4 males and 6 females, aged from 43 to 64 years, with a median age of 55 years. All 10 patients underwent Da Vinci robotic assisted vagus nerve-preserving splenectomy and azygoportal discon-nection. Observation indicators surgical situations, intraoperative autologous blood transfusion, conversion to open laparotomy, allogeneic blood transfusion, the operation time, volume of intra-operative blood loss, time to initial diet intake, time for out-of-bed activity, postoperative complica-tion, duration of postoperative hospital stay and follow-up. Follow-up was conducted using out-patient examination and telephone interview to detect recurrent gastrointestinal hemorrhage and gastric retention up to July 2021. Measurement data with normal distribution were represented as Mean± SD and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:All 10 patients underwent Da Vinci robotic assisted nerve-preserving splenectomy and azygoportal disconnection successfully, with intraopera-tive autologous blood transfusion and without conversion to open laparotomy or allogeneic blood transfusion. The operation time, volume of intraoperative blood loss, time to initial diet intake and time for out-of-bed activity of 10 patients were (180±14)minutes, (111±28)mL, (1.5±0.5)days and (2.5±0.7)days, respectively. Of the 10 patients, 1 case underwent mild pancreatic leakage, 1 case underwent pneumonia, 2 cases underwent portal vein thrombosis and 3 cases underwent splenic vein thrombosis. Patients with postoperative complications was cured after conservative treatment. The duration of postoperative hospital stay of 10 patients was (8.9±0.9)days. All 10 patients were discharged without perioperative death and followed up for 1 to 4 months, with a median follow-up time of 3 months. There was no patient undergoing gastrointestinal hemorrhage and gastric reten-tion.Conclusion:Da Vinci robotic assisted vagus nerve-preserving splenectomy and azygoportal disconnection is safe and feasible for the treatment of cirrhotic portal hypertension patients with esophagogastric variceal bleeding and hypersplenism.