Robot-Assisted Partial Splenectomy for a Nonparasitic Splenic Cyst in a 15-Year-Old Girl

Abstract

Introduction:

Nonparasitic splenic cysts are rare in the pediatric population. ^1,2 Although they are typically asymptomatic, abdominal pain and early satiety can occur secondary to compression of adjacent organs. Management options include observation, cystectomy, partial or total splenectomy, and percutaneous aspiration with or without sclerotherapy. ¹ Given the 3.2% prevalence and 1.4% mortality rate of overwhelming postsplenectomy infection (OPSI), ³ spleen-preserving techniques are highly desirable. However, there is no consensus regarding the best approach to achieve this. We present the case of a 15-year-old girl with a nonparasitic splenic cyst causing mass effect on adjacent organs and abdominal pain thought to be precipitating seizures in the setting of a complex brain malformation. We elected to manage this patient by performing a robot-assisted partial splenectomy.

Materials and Methods:

Magnetic resonance imaging showed a 4.2 × 4.3 × 2.8 cm simple appearing cystic structure within the upper splenic parenchyma. Treatment options discussed with the family included aspiration with sclerotherapy, robotic partial splenectomy, or robotic complete splenectomy. As the family wanted definitive treatment and the possibility of splenic preservation, a partial splenectomy was selected. All vaccinations were done preoperatively in case complete splenectomy was needed. To begin the robot-assisted repair, a camera was inserted into the umbilicus, and three 8 mm trocars were placed horizontally across the abdomen in line with the umbilical port. Dissection began with division of gastrosplenic attachments using the vessel sealer, followed by taking down the splenic flexure. The short gastric vessels were then divided using the vessel sealer until the superior aspect of the spleen was ischemic. The spleen was then divided across the superior pole with the vessel sealer device with good hemostasis, followed by using a Vicryl suture to oversew the cut edge of the spleen to further promote hemostasis. The resected portion of the spleen was then removed through the umbilical incision.

Results:

The patient recovered well postoperatively and was discharged home on postoperative day 2. Her pathology report was consistent with a simple epithelial cyst.

Conclusion:

Partial splenectomy avoids the morbidity associated with total splenectomy, including the 3.2% lifetime risk of OPSI, and has, therefore, gained significant attention for the past two decades. ⁴ Previous comparison of a laparoscopic and robotic approach to partial splenectomy suggested that a robotic approach may allow for more delicate and precise vascular dissection, a lower blood loss, and better evaluation of the splenic remnant volume; these approaches maintained comparable operative times, hospital stay, complications, and conversion rates. ^5,6 Although further research will be needed for full evaluation of the advantages and disadvantages of each approach, a robot-assisted approach warrants consideration for complex pediatric splenic procedures.

No competing financial interests exist.

No funding was received for this article.

Patient Consent Statement:

Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

This video was presented as a video presentation at the 2022 International Pediatric Endosurgery Group (IPEG) Annual Meeting (Miami, Florida).

Runtime of video: 3 mins 51 secs