Srikanth Parsi, MD, Suzanna Hosein, Veeraiah Siripurapu, MD. Lankenau Medical Center
INTRODUCTION: Minimally invasive splenectomy is gaining popularity for non-traumatic splenic disorders requiring splenectomy. We report a case of successful robotic assisted splenectomy for massive splenomegaly in a patient with history of sarcoidosis. To our knowledge, our case is the largest intact spleen removed without fragmentation by minimally invasive approach.
CASE REPORT: A 40-year-old female with history of sarcoidosis and diabetes was considered for splenectomy. She had significant weight loss, fatigue, abdominal pain and vomiting for several months. CT scan revealed retroperitoneal and mediastinal lymphadenopathy along with massive splenomegaly (Fig 1). CT guided biopsy of retroperitoneal lymph node was negative for lymphoproliferative neoplasm. We recommended minimally invasive splenectomy due to symptomology and to facilitate diagnosis.
The Si robot was used for the placement of ports in the right and left mid abdomen. Three robotic arms and an assistance port were used to take down the medial attachments of spleen The hilum was then isolated and taken down with a 60 mm white load stapler. As access to the lateral attachments of the spleen was limited by its weight, laparoscopy was used in final stage. Tilting of the table facilitated the dissection of superior attachments of spleen. The spleen was placed in a bag and removed intact through a small midline incision. Her post-operative recovery was uneventful and was discharged on day five.
Gross weight of the spleen was 1905 grams and measured 34 x 20 x 6.5 cm (Fig 2). Pathology revealed complete replacement of spleen by non-necrotizing epithelioid granuloma suggestive of sarcoidosis
Fig 1: Coronal section of CT abdomen and pelvis demonstrating massive spleen measuring 23×16.2×10.6cm
Fig 2: Gross specimen of intact spleen removed without fragmentation with robotic assistance
CONCLUSION: Although laparoscopic approach is feasible in majority of cases requing splenectomy, it does have limitations especially with massive spleens. Robotic assisted splenectomy is a viable alternative for massive spleens which are technically difficult with standard laparoscopic approach.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80532
Program Number: P693
Presentation Session: Poster (Non CME)
Presentation Type: Poster