Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis.

BACKGROUND: Laparoscopic distal pancreatectomy (LDP) reduces postoperative morbidity, hospital stay and recovery as compared with open distal pancreatectomy. Many authors believe that robotic surgery can overcome the difficulties and technical limits of LDP thanks to improved surgical manipulation and better visualization. Few studies in the literature have compared the two methods in terms of surgical and oncological outcome. The aim of this study was to compare the results of robotic (RDP) and laparoscopic distal pancreatectomy. METHODS: A systematic review and meta-analysis was conducted of control studies published up to December 2016 comparing LDP and RDP. Two Reviewers independently assessed the eligibility and quality of the studies. The meta-analysis was conducted using either the fixed-effect or the random-effect model. RESULTS: Ten studies describing 813 patients met the inclusion criteria. This meta-analysis shows that the RDP group had a significantly higher rate of spleen preservation [OR 2.89 (95% confidence interval 1.78-4.71, p < 0.0001], a lower rate of conversion to open OR 0.33 (95% CI 0.12-0.92), p = 0.003] and a shorter hospital stay [MD -0.74; (95% CI -1.34 -0.15), p = 0.01] but a higher cost than the LDP group, while other surgical outcomes did not differ between the two groups. CONCLUSION: This meta-analysis suggests that the RDP procedure is safe and comparable in terms of surgical results to LDP. However, even if the RDP has a higher cost compared to LDP, it increases the rate of spleen preservation, reduces the risk of conversion to open surgery and is associated to shorter length of hospital stay.

Clinical evaluation of a hyaluronan-based gel following microsurgical reconstruction of peripheral nerves of the hand.

A controlled clinical trial was performed to investigate the safety and efficacy of the hyaluronate-based gel polymer Hyaloglide after microsurgical reconstruction of peripheral nerves of the hand. Thirty patients were randomized to receive either no postsurgical treatment (n = 16) or Hyaloglide (n = 14) and were clinically evaluated at various intervals for 1 year. The application of Hyaloglide posed no safety concerns. Efficacy was assessed by the recovery of sensitivity, measurement of pain, and progression of Tinel's sign. The Hyaloglide-treated group showed better improvement in recovery from pain, approaching statistical significance during the first 3 months postsurgery. Likewise, recovery of sensitivity was also higher in the Hyaloglide-treated group throughout the entire follow-up period, and the distance of Tinel's sign was longer in the Hyaloglide-treated group (P < 0.05 at day 30). The application of Hyaloglide may improve recovery of sensitivity and decrease pain following microsurgical repair of the peripheral nerves of the hand.