Robot-Assisted Splenectomy
At the present state of the art, it is unlikely to prove that robotics produces significant advantages in respect to traditional laparoscopy for patients suitable for a minimally invasive splenectomy. However, robotic splenectomy still remains an importan
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Luciano Casciola, Alberto Patriti, and Graziano Ceccarelli
Introduction
Indications to Minimally Invasive Splenectomy: When a RobotLaparoscopic splenectomy (LS) was first described Assisted Approach? in 1991 by Delaitre, and in the last two decades, it has progressively become the procedure of choice for nontraumatic splenic lesions [1, 2]. LS can be performed with times comparable to those required for open splenectomy, as well as minimal morbidity and less postoperative pain. The postoperative length of stay is also significantly reduced following LS, which in turn can lead to decreased hospital costs [3]. Laparoscopy does, however, have some disadvantages, including two-dimensional vision and rigid instrumentation, which can make splenectomy for splenomegaly challenging. Robotic surgery (da Vinci®; Intuitive Surgical, Sunnyvale, CA) can overcome these limitations providing “wrist-like” action of the instruments and threedimensional visualization, resulting in highresolution binocular view of the surgical field and more precise dissection of the splenic vessels even in difficult situations [4].
L. Casciola, M.D. • A. Patriti, M.D., Ph.D. (*) G. Ceccarelli, M.D. Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, San Matteo degli Infermi Hospital, Via Loreto, 3, Spoleto 06049, Italy e-mail: [email protected]
LS can be considered a well-accepted approach for the differential diagnosis and staging of lymphoproliferative diseases; for restaging after chemotherapy or radiotherapy in abdominal lymphoma, as well as when diseases recurrence is suspected; for the treatment of cystic or solid splenic lesions; and for the surgical treatment of blood disorders. The most accepted indications to LS for hematological diseases are idiopathic thrombocytopenic purpura not responsive to conventional treatments, autoimmune hemolytic anemia, spherocytosis, beta-thalassemia, hairy-cell leukemia, chronic idiopathic myelofibrosis, and splenic lymphoma. To date, studies conducted to investigate the role of robotassisted splenectomy (RS) did not show any significant advantage over LS [4]. Nevertheless, the endo-wristed movements and three-dimensional view may result advantageous in case of difficult splenectomies in order to reduce the complication and conversion rate. Whether a LS is considered demanding can be ascribed to four factors. Anatomy of the pancreatic tail can make demanding spleen pedicle dissection when a bulky or “intrasplenic” pancreatic tail is present. Anatomy of the splenic vessels is another factor. Splenic artery and vein branching off in multiple, short vessels can hamper their identification and ligation. Spleen volume and consistency is the most common factor determining
K.C. Kim (ed.), Robotics in General Surgery, DOI 10.1007/978-1-4614-8739-5_26, © Springer Science+Business Media New York 2014
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conversion of LS and the only one that can be easily determined in the preoperative setting. The last condition impairing the good outcome of L
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