{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:27:35Z","timestamp":1790717255638,"version":"4.1.0"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Surg Int"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Laparoscopic splenectomy (LS) is the preferred surgical approach for pediatric patients requiring splenectomy, though gaps remain regarding spleen size impact on outcomes and conversion rates, especially in children with hematologic disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive literature search was conducted across PubMed, Medline, CINAHL, Embase, and Cochrane Library, from inception to January 2025, following PRISMA guidelines and registered with PROSPERO (CRD42025644989). Statistical analysis was performed using a random-effects model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The initial search yielded 216 studies, 19 studies with 1898 pediatric patients included. Of those, 1202 underwent LS and 696 open splenectomy (OS). LS was associated with shorter hospital stay (MD: \u22121.59\u00a0days, 95% CI: \u22122.18 to \u22121.00,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.00001), faster initiation of oral feeding (MD: \u22120.68\u00a0days, 95% CI: \u22121.07 to \u22120.29,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0006), fewer transfusions (OR\u2009=\u20090.38, 95% CI: 0.23 to 0.62,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0001), and conversion to OS in 2.7% of cases. OS showed shorter operative time (MD: 60.4\u00a0min, 95% CI: 37.4 to 83.4,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.00001), and improved accessory spleen removal (OR: 1.91, 95% Cl: 1.02 to 3.57,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings support LS as a safe and effective technique in pediatric hematologic patients and provide updated evidence to guide surgical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00383-025-06208-2","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T19:18:12Z","timestamp":1760728692000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Laparoscopic versus open splenectomy in non-traumatic pediatric patients: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"41","author":[{"given":"Alma","family":"Sato","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marios","family":"Alogakos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James W. F.","family":"Burns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dafni-Stravroula","family":"Grammenou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebaney","family":"Ghotra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily E.","family":"Lugard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charbel","family":"Chidiac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian Aloysius","family":"Than","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayato","family":"Nakanishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaun M.","family":"Kunisaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"issue":"1","key":"6208_CR1","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.jpedsurg.2023.09.010","volume":"59","author":"SJ Mack","year":"2024","unstructured":"Mack SJ, Pace DJ, Patil S, Cooke-Barber J, Boelig MM, Berman L (2024) Concurrent cholecystectomy does not increase splenectomy morbidity in patients with hemolytic anemia: a pediatric NSQIP analysis. J Pediatr Surg 59(1):117\u2013123. https:\/\/doi.org\/10.1016\/j.jpedsurg.2023.09.010","journal-title":"J Pediatr Surg"},{"issue":"2","key":"6208_CR2","doi-asserted-by":"publisher","first-page":"588","DOI":"10.5530\/ijmedph.2024.2.113","volume":"14","author":"S Varghese","year":"2024","unstructured":"Varghese S, Akhtarkhavri A, Jensen J, Patra SR, Algud SM (2024) Comparative analysis of laparoscopic splenectomy versus open splenectomy in pediatric patients: a retrospective study. Int J Med Public Health 14(2):588\u2013592. https:\/\/doi.org\/10.5530\/ijmedph.2024.2.113","journal-title":"Int J Med Public Health"},{"key":"6208_CR3","doi-asserted-by":"crossref","unstructured":"Rescorla FJ, Engum SA, West KW, Tres Scherer LR, Rouse TM, Grosfeld JL (2002) Laparoscopic splenectomy has become the gold standard in children. Am Surg 68(3):297\u2013301; discussion 301\u2013302. https:\/\/pubmed.ncbi.nlm.nih.gov\/11894857\/","DOI":"10.1177\/000313480206800315"},{"issue":"5","key":"6208_CR4","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1053\/jpsu.2000.6010","volume":"35","author":"RK Minkes","year":"2000","unstructured":"Minkes RK, Lagzdins M, Langer JC (2000) Laparoscopic versus open splenectomy in children. J Pediatr Surg 35(5):699\u2013701. https:\/\/doi.org\/10.1053\/jpsu.2000.6010","journal-title":"J Pediatr Surg"},{"issue":"1","key":"6208_CR5","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1007\/s12288-014-0379-z","volume":"31","author":"\u00c7 Konca","year":"2015","unstructured":"Konca \u00c7, S\u00f6ker M, Ta\u015f MA, Y\u0131ld\u0131r\u0131m R (2015) Hereditary spherocytosis: evaluation of 68 children. Indian J Hematol Blood Transfus 31(1):127\u2013132","journal-title":"Indian J Hematol Blood Transfus"},{"issue":"10","key":"6208_CR6","doi-asserted-by":"publisher","first-page":"2802","DOI":"10.1007\/s00464-012-2249-9","volume":"26","author":"C Vasilescu","year":"2012","unstructured":"Vasilescu C, Stanciulea O, Tudor S (2012) Laparoscopic versus robotic subtotal splenectomy in hereditary spherocytosis. Potential advantages and limits of an expensive approach. Surg Endosc 26(10):2802\u20132809. https:\/\/doi.org\/10.1007\/s00464-012-2249-9","journal-title":"Surg Endosc"},{"issue":"8","key":"6208_CR7","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1016\/0022-3468(95)90022-5","volume":"30","author":"DC Moores","year":"1995","unstructured":"Moores DC, McKee MA, Wang H, Fischer JD, Smith JW, Andrews HG (1995) Pediatric laparoscopic splenectomy. J Pediatr Surg 30(8):1201\u20131205. https:\/\/doi.org\/10.1016\/0022-3468(95)90022-5","journal-title":"J Pediatr Surg"},{"issue":"9","key":"6208_CR8","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1177\/000313480106700909","volume":"67","author":"VS Reddy","year":"2001","unstructured":"Reddy VS, Phan HH, O\u2019Neill JA et al (2001) Laparoscopic versus open splenectomy in the pediatric population: a contemporary single-center experience. Am Surg 67(9):859\u2013864","journal-title":"Am Surg"},{"issue":"4","key":"6208_CR9","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000024436","volume":"100","author":"QL Zhu","year":"2021","unstructured":"Zhu QL, Wu W (2021) Comparison of clinical efficacy of laparoscopic splenectomy versus open splenectomy for idiopathic thrombocytopenic purpura. Medicine 100(4):e24436. https:\/\/doi.org\/10.1097\/md.0000000000024436","journal-title":"Medicine"},{"issue":"4","key":"6208_CR10","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1016\/j.amjsurg.2011.05.014","volume":"203","author":"VP Koshenkov","year":"2011","unstructured":"Koshenkov VP, N\u00e9meth ZH, Carter MS (2011) Laparoscopic splenectomy: outcome and efficacy for massive and supramassive spleens. Am J Surg 203(4):517\u2013522. https:\/\/doi.org\/10.1016\/j.amjsurg.2011.05.014","journal-title":"Am J Surg"},{"issue":"4","key":"6208_CR11","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1007\/s00464-018-6394-7","volume":"33","author":"RD Shin","year":"2018","unstructured":"Shin RD, Lis R, Levergood NR, Brooks DC, Shoji BT, Tavakkoli A (2018) Laparoscopic versus open splenectomy for splenomegaly: the verdict is unclear. Surg Endosc 33(4):1298\u20131303. https:\/\/doi.org\/10.1007\/s00464-018-6394-7","journal-title":"Surg Endosc"},{"issue":"44","key":"6208_CR12","first-page":"2263","volume":"20","author":"B Delaitre","year":"1991","unstructured":"Delaitre B, Maignien B (1991) Splenectomy by the laparoscopic approach. Report of a case. Presse Med 20(44):2263","journal-title":"Presse Med"},{"issue":"5","key":"6208_CR13","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1016\/0022-3468(93)90033-h","volume":"28","author":"S Tulman","year":"1993","unstructured":"Tulman S, Holcomb GW, Karamanoukian HL, Reynhout J (1993) Pediatric laparoscopic splenectomy. J Pediatr Surg 28(5):689\u2013692. https:\/\/doi.org\/10.1016\/0022-3468(93)90033-h","journal-title":"J Pediatr Surg"},{"issue":"12","key":"6208_CR14","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1007\/s00383-012-3215-2","volume":"28","author":"XG Deng","year":"2012","unstructured":"Deng XG, Maharjan A, Tang J et al (2012) A modified laparoscopic splenectomy for massive splenomegaly in children with hematological disorder: a single institute retrospective clinical research. Pediatr Surg Int 28(12):1201\u20131209. https:\/\/doi.org\/10.1007\/s00383-012-3215-2","journal-title":"Pediatr Surg Int"},{"issue":"3","key":"6208_CR15","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1007\/s00383-015-3845-2","volume":"32","author":"S Feng","year":"2015","unstructured":"Feng S, Qiu Y, Li X et al (2015) Laparoscopic versus open splenectomy in children: a systematic review and meta-analysis. Pediatr Surg Int 32(3):253\u2013259. https:\/\/doi.org\/10.1007\/s00383-015-3845-2","journal-title":"Pediatr Surg Int"},{"issue":"12","key":"6208_CR16","doi-asserted-by":"publisher","first-page":"2675","DOI":"10.1007\/s00464-008-0258-5","volume":"23","author":"AMS Altaf","year":"2009","unstructured":"Altaf AMS, Sawatzky M, Ellsmere J et al (2009) Laparoscopic accessory splenectomy: the value of perioperative localization studies. Surg Endosc 23(12):2675\u20132679. https:\/\/doi.org\/10.1007\/s00464-008-0258-5","journal-title":"Surg Endosc"},{"issue":"7","key":"6208_CR17","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1007\/bf01258713","volume":"12","author":"C Esposito","year":"1997","unstructured":"Esposito C, Corcione F, Garipoli V, Ascione G (1997) Pediatric laparoscopic splenectomy: are there real advantages in comparison with the traditional open approach? Pediatr Surg Int 12(7):509\u2013510. https:\/\/doi.org\/10.1007\/bf01258713","journal-title":"Pediatr Surg Int"},{"issue":"4","key":"6208_CR18","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1016\/s0039-6060(03)00312-x","volume":"134","author":"ER Winslow","year":"2003","unstructured":"Winslow ER, Brunt LM (2003) Perioperative outcomes of laparoscopic versus open splenectomy: a meta-analysis with an emphasis on complications. Surgery 134(4):647\u2013653. https:\/\/doi.org\/10.1016\/s0039-6060(03)00312-x","journal-title":"Surgery"},{"issue":"7","key":"6208_CR19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097","volume":"6","author":"D Moher","year":"2009","unstructured":"Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):E1000097","journal-title":"PLoS Med"},{"key":"6208_CR20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919","volume":"355","author":"JA Sterne","year":"2016","unstructured":"Sterne JA et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919","journal-title":"BMJ"},{"issue":"7414","key":"6208_CR21","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","volume":"327","author":"JP Higgins","year":"2003","unstructured":"Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557\u2013560","journal-title":"BMJ"},{"key":"6208_CR22","unstructured":"Higgins JPT, Cochrane Collaboration (2020) Cochrane handbook for systematic reviews of interventions. In: Higgins JPT, Green S (eds) Cochrane book series, 2nd edn. Hoboken, NJ: Wiley-Blackwell."},{"issue":"9","key":"6208_CR23","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1089\/lap.2022.0038","volume":"32","author":"C Esposito","year":"2022","unstructured":"Esposito C, Luca UD, Cerulo M et al (2022) Twenty-five-year experience with minimally invasive splenectomy in children: from minilaparotomy to use of sealing devices and indocyanine green fluorescence technology: tips and tricks and technical considerations. J Laparoendosc Adv Surg Tech A 32(9):1010\u20131015. https:\/\/doi.org\/10.1089\/lap.2022.0038","journal-title":"J Laparoendosc Adv Surg Tech A"},{"issue":"3","key":"6208_CR24","doi-asserted-by":"publisher","DOI":"10.4293\/jsls.2014.00245","volume":"18","author":"ME Hassan","year":"2014","unstructured":"Hassan ME, Al Ali K (2014) Massive splenomegaly in children: laparoscopic versus open splenectomy. JSLS J Soc Laparoendosc Surg 18(3):e2014.00245. https:\/\/doi.org\/10.4293\/jsls.2014.00245","journal-title":"JSLS J Soc Laparoendosc Surg"},{"key":"6208_CR25","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.jss.2019.02.045","volume":"240","author":"AF Utria","year":"2019","unstructured":"Utria AF, Goffredo P, Keck K, Shelton JS, Shilyansky J, Hassan I (2019) Laparoscopic splenectomy: has it become the standard surgical approach in pediatric patients? J Surg Res 240:109\u2013114. https:\/\/doi.org\/10.1016\/j.jss.2019.02.045","journal-title":"J Surg Res"},{"issue":"4","key":"6208_CR26","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1177\/1553350611400758","volume":"18","author":"J Zhu","year":"2011","unstructured":"Zhu J, Ye H, Wang Y (2011) Laparoscopic versus open pediatric splenectomy for massive splenomegaly. Surg Innov 18(4):349\u2013353. https:\/\/doi.org\/10.1177\/1553350611400758","journal-title":"Surg Innov"},{"issue":"5","key":"6208_CR27","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1007\/s00383-009-2352-8","volume":"25","author":"A Alwabari","year":"2009","unstructured":"Alwabari A, Parida L, Al-Salem AH (2009) Laparoscopic splenectomy and\/or cholecystectomy for children with sickle cell disease. Pediatr Surg Int 25(5):417\u2013421. https:\/\/doi.org\/10.1007\/s00383-009-2352-8","journal-title":"Pediatr Surg Int"},{"issue":"1","key":"6208_CR28","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/s0022-3476(97)70122-7","volume":"131","author":"RA Farah","year":"1997","unstructured":"Farah RA, Rogers ZR, Thompson WR, Hicks BA, Guzzetta PC, Buchanan GR (1997) Comparison of laparoscopic and open splenectomy in children with hematologic disorders. J Pediatr 131(1):41\u201346. https:\/\/doi.org\/10.1016\/s0022-3476(97)70122-7","journal-title":"J Pediatr"},{"issue":"10","key":"6208_CR29","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1089\/lap.2019.0123","volume":"29","author":"CG Fachin","year":"2019","unstructured":"Fachin CG, Amado F, Romaniello G et al (2019) Open versus laparoscopic splenectomies in children: a comparative study performed at a public hospital in Brazil. J Laparoendosc Adv Surg Tech A 29(10):1357\u20131361. https:\/\/doi.org\/10.1089\/lap.2019.0123","journal-title":"J Laparoendosc Adv Surg Tech A"},{"issue":"1","key":"6208_CR30","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/s0022-3468(96)90330-9","volume":"31","author":"PG Janu","year":"1996","unstructured":"Janu PG, Rogers DA, Lobe TE (1996) A comparison of laparoscopic and traditional open splenectomy in childhood. J Pediatr Surg 31(1):109\u2013114. https:\/\/doi.org\/10.1016\/s0022-3468(96)90330-9","journal-title":"J Pediatr Surg"},{"issue":"4","key":"6208_CR31","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1097\/01.xps.0000522255.44536.30","volume":"13","author":"MG Khirallah","year":"2017","unstructured":"Khirallah MG, Eldesouki NI, Hasaballah SZ, Elshanshoury M (2017) Laparoscopic versus open splenectomy in children with benign hematological diseases in children. Ann Pediatr Surg 13(4):194\u2013198. https:\/\/doi.org\/10.1097\/01.xps.0000522255.44536.30","journal-title":"Ann Pediatr Surg"},{"issue":"9","key":"6208_CR32","doi-asserted-by":"publisher","first-page":"979","DOI":"10.4240\/wjgs.v13.i9.979","volume":"13","author":"M Makansi","year":"2021","unstructured":"Makansi M, Hutter M, Theilen TM, Fiegel HC, Rolle U, Gfroerer S (2021) Comparison of perioperative outcomes between laparoscopic and open partial splenectomy in children and adolescents. World J Gastrointest Surg 13(9):979\u2013987. https:\/\/doi.org\/10.4240\/wjgs.v13.i9.979","journal-title":"World J Gastrointest Surg"},{"key":"6208_CR33","unstructured":"Qureshi FG, Ergun O, Sandulache VC, et al (2005) Laparoscopic splenectomy in children. JSLS 9(4):389\u2013392. https:\/\/pubmed.ncbi.nlm.nih.gov\/16381351\/"},{"issue":"8","key":"6208_CR34","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1001\/archsurg.1997.01430320024003","volume":"132","author":"JH Waldhausen","year":"1997","unstructured":"Waldhausen JH, Tapper D (1997) Is pediatric laparoscopic splenectomy safe and cost-effective? Arch Surg 132(8):822\u2013822. https:\/\/doi.org\/10.1001\/archsurg.1997.01430320024003","journal-title":"Arch Surg"},{"issue":"12","key":"6208_CR35","doi-asserted-by":"publisher","first-page":"9070","DOI":"10.1007\/s00464-023-10462-7","volume":"37","author":"Y Li","year":"2023","unstructured":"Li Y, Wang C, Chen W et al (2023) Selection of surgical modality for massive splenomegaly in children. Surg Endosc 37(12):9070\u20139079. https:\/\/doi.org\/10.1007\/s00464-023-10462-7","journal-title":"Surg Endosc"},{"issue":"12","key":"6208_CR36","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1007\/bf00190159","volume":"9","author":"K Yoshida","year":"1995","unstructured":"Yoshida K, Yamazaki Y, Mizuno R et al (1995) Laparoscopic splenectomy in children. Surg Endosc 9(12):1279\u20131282. https:\/\/doi.org\/10.1007\/bf00190159","journal-title":"Surg Endosc"},{"issue":"11","key":"6208_CR37","doi-asserted-by":"publisher","first-page":"3186","DOI":"10.1007\/s00464-012-2314-4","volume":"26","author":"AS Al-Mulhim","year":"2012","unstructured":"Al-Mulhim AS (2012) Laparoscopic splenectomy for massive splenomegaly in benign hematological diseases. Surg Endosc 26(11):3186\u20133189. https:\/\/doi.org\/10.1007\/s00464-012-2314-4","journal-title":"Surg Endosc"},{"issue":"5","key":"6208_CR38","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1308\/003588414x14055925060479","volume":"97","author":"S Somasundaram","year":"2015","unstructured":"Somasundaram S, Massey L, Gooch D, Reed J, Menzies D (2015) Laparoscopic splenectomy is emerging \u201cgold standard\u201d treatment even for massive spleens. Ann R Coll Surg Engl 97(5):345\u2013348. https:\/\/doi.org\/10.1308\/003588414x14055925060479","journal-title":"Ann R Coll Surg Engl"}],"container-title":["Pediatric Surgery International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00383-025-06208-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00383-025-06208-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00383-025-06208-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T09:27:24Z","timestamp":1763630844000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00383-025-06208-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,17]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6208"],"URL":"https:\/\/doi.org\/10.1007\/s00383-025-06208-2","relation":{},"ISSN":["1437-9813"],"issn-type":[{"value":"1437-9813","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,17]]},"assertion":[{"value":"31 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"317"}}