LAUSR

BACKGROUND splenic artery aneurysms (SAAs) are the most frequent visceral aneurysms, with a life-threatening risk in case of rupture. Our systematic review investigated the features of minimally invasive surgical approaches in vascular surgery for SAAs: robotic and laparoscopy. METHODS PubMed, EMBASE and the Web of Science (WOS) were systematically searched for robotic or laparoscopic surgery reports in splenic artery aneurysm up to January 2020. The outcomes of the study were operative time, overall morbidity, intra and postoperative complications, conversion rate, and length of hospital stay. RESULTS a total of 40 studies (29 case report, 8 case series, 1 randomized trial, 1 video, 1 image), including 107 patients, were considered eligible for the review. Mean operative time was 164.2 ±75.9 min (laparoscopy) 165 min (± 75.6 min) and 150 min (± 87.7 min) for robotic procedures. Four cases of conversion (4.8% of all laparoscopic procedures) were reported; no conversion in the robotic series. Overall morbidity was 11.2%, the most common complications were postoperative spleen infarction and pancreatitis. Medium estimated blood loss (EBL) was 105.2 mL (± 239.5 mL) (robotic 186.6 (± 202.4) mL, laparoscopic 63 (0-270) mL). Overall length of stay (LOS) was 5.43 (± 5.5) days (robotic 6.1 and laparoscopic 5.5 days. Neither mortality nor reinterventions were observed in robotic and laparoscopic series. CONCLUSIONS according to the available literature, laparoscopy and robotic surgery represent, in selected cases, a valid choice to treat SAAs. Multidisciplinary teams, comprehensive of vascular and general surgeons skilled in robotic and laparoscopic procedures, could permit to offer a tailored treatment for each patient. The rarity of this disease does not allow to perform randomized controlled trials about of, thus the possibility to reach definitive conclusions.