Robotic single-site splenectomy

Jae Hoon Lee, MD, PhD. Asan Medical Center

Background : Laparoscopic splenectomy is the first surgical choice for benign splenic disease. Some studies have reported single-site laparoscopic splenectomy, but this technique poses many technical difficulties such as instrument clashing, lack of triangulation, odd angles, and lack of space. Recently, robotic single-site operation has been introduced as a more feasible approach.

Methods : We present the case of a 28 year-old woman with a symptomatic splenic cyst, which had been increasing in size for 3 years after the first diagnosis. We performed robotic single-site splenectomy using da Vinci single-site flatform.

Results : The operation using the da Vinci single-site platform was performed in 195 minutes without intraoperative or postoperative complications. The vessel ligations were performed in short gastric, splenic artery, and splenic vein order. Around the spleen lower pole, a splenocolic attachment was dissected to the lower margin of the splenorenal ligament. Using the stomach-hanging method, we obtained a favorable view of the spleen. Subsequently, ligation of short gastric vessels was performed and the splenic artery and vein were divided individually, isolated at the hilum, and ligated using hemolocks and a Harmonic scalpel. No additional ports, such as a Veress needle or intraabdominal drain, were used. The patient was discharged on day 3 after surgery.

Conclusions : Robotic single-access splenectomy has some technical advantages over previous robotic or laparoscopic single-access approaches. Nonetheless, additional studies are needed to compare cost-effectiveness and safety.

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