Robot-assisted minimally invasive partial resection of the spleen for nonparasitic splenic cyst

Graziano Pernazza, MD, Annibale D’Annibale, MD. San Giovanni-Addolorata Hospital, Rome.

BACKGROUND: Laparoscopy has become the technique of choice for the surgical treatment of non-traumatic pathologies of the spleen. Large published series demonstrated the effectiveness and benefits of the minimally invasive approach.
In certain pathological conditions a partial resection seems an appropriate option not to lose the hematological and immunological functions carried out by the spleen and to reduce the incidence of potential septic complications and postoperative sequelae.
Several studies have shown laparoscopic partial splenectomy to be feasible and safe with good clinical results.

This procedure, performed with minimally invasive techniques, requires a dissection of the vascular splenic hilum that may be challenging in conventional laparoscopy.
Furthermore, the site of the lesion may influence the operative strategy, being the lesions of the lower pole easier to resect than those of the upper pole.

MATERIAL AND METHODS: The role of robotic surgery in this particular area has not been adequately investigated, but the case studies available have shown the usefulness of this technology, especially in more complex cases.
This paper illustrates the use of robotic technology in a case of partial splenectomy performed in a young woman for a simple large cyst occupying the entire upper pole of the spleen.

The preliminary vascular control of the splenic hilum is mandatory and performed according to the well standardized strategy developed in the laparoscopic approach. The common trunk of the splenic artery and vein are dissected and encircled by vessel-loops, then carrying out a selective vascular dissection of the splenic hilum and, finally, sectioning the parenchyma along the ischemic demarcation line, with ultrasonic dissector.

RESULTS: Intraoperative blood losses were negligibile. The postoperative course was uneventful and the echo-color-doppler control, performed after one month postoperatively, shows the perfect vascular flow and functionality of the residual parenchyma.

CONCLUSIONS: This experience confirm the safety and feasibility of minimally invasive surgery even in partial resection of the spleen and the particular usefulness of robotic technology in making extremely precise and safe dissection, both in vascular control and parenchymal transection.

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