ROBOTIC SPLENECTOMIES: A MULTICENTRE RETROSPECTIVE STUDY

Abstract

INTRODUCTION

The number of splenectomies performed has significantly decreased for two main reasons: the conservative management of blunt abdominal trauma in hemodynamically stable patients and a notable reduction in splenectomies performed for hematologic conditions. Currently, splenectomies are most performed laparoscopically. While the robotic approach has gained widespread use in general surgery, the number of robotic splenectomies (RS) performed remains minimal, making it challenging to compare the outcomes with the laparoscopic approach, which is considered the gold standard. This study aims to present the tri-center experience with RS and analyze the indications and results obtained.

MATERIAL AND METHODS

We conducted a retrospective observational study of consecutive patients across three centers from January 2021 to May 2024. The inclusion criteria included patients older than 18 and of any ASA classification. The RS technique involved placing four robotic ports (two 8 mm and two 12 mm) and an auxiliary infra-umbilical trocar if needed. The surgical table was positioned at 10° anti-Trendelenburg and 3-5° right lateral decubitus, with the robot placed on the patient's left side. We collected data on preoperative, intraoperative, and postoperative variables.

RESULTS

A total of 12 RS were performed. The median age of the patients was 44.5 years (IQR:41–55.8), with a gender distribution of seven women and five men. Indications included symptomatic cystic lesions in five patients (two with hydatidosis and three with splenic cysts), two patients with splenic artery aneurysms unresponsive to interventional radiology, four patients with immune thrombocytopenic purpura refractory to medical treatment, and one patient with suspected lymphoma. The median console time for the surgeries was 102.5 minutes (IQR:74.8–187.5). All 12 patients underwent total splenectomies, and one patient required an atypical gastric resection. Mean bleeding was 15 cc. An abdominal drain was placed in seven cases (58.7%). There were no major Clavien-Dindo complications. One patient developed a postoperative fever, for which antibiotics were prescribed (Clavien-Dindo II). The median hospital stay was 2.5 days (IQR:1–4), and all patients remained asymptomatic at follow-up.

CONCLUSION

This study presents the outcomes of twelve RS performed across three centers for various pathologies. The results demonstrated reduced surgical time, minimal operative bleeding, no significant complications, a short hospital stay, and complete clinical resolution. In conclusion, RS is a safe and reliable technique that may be a viable alternative to the laparoscopic approach.