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IntroductionWhile laparoscopic splenectomy (LS) has been widely used in benign splenic tumor, more concerns have been raised for postoperatively short-term and long-term complications. Laparoscopic partial splenectomy (LPS) is a surgical option, to preserve splenic function, and reduce postoperative complications. The aim of our study was to retrospectively identify the safety and feasibility of LPS compared with LS in patients with splenic benign tumor.Materials and methodsFrom 2014 to 2024, a total of 165 patients diagnosed with occupational splenic lesions underwent splenectomy, of whom 87 underwent LPS and 78 underwent LS. We compare the perioperative parameters and long term follow up between these two groups.ResultsThe etiology of splenic space-occupying lesions was nonparasitic splenic cysts, followed by splenic lymphangioma and splenic hemangioma. Of the patients with LPS, 54 underwent conventional surgery with blockage of the splenic arterial branch and resection along the ischemic line (RAIL), and 33 underwent with our modified total splenic blood supply blockade followed by resection alone the tumor edge (RATE). The tumor size, the operative time and estimated blood loss were comparable between the LPS and LS groups. One patient developed abnormal signs during the LPS procedure and was promptly referred for LS. The LPS group had fewer pancreatic leakage, incision infection, and pulmonary infection. As for different vascular types, patients with LS under all branches of the splenic artery had a longer time to resume postoperative feeding. As for the comparison of RAIL and RATE, estimated blood and operative time were significantly reduced in patients receiving RATE. Postoperative complications were the same in patients underwent each surgical procedures.ConclusionLPS is a viable approach for patients with splenic benign tumor. We introduce the tumor artery supply types to indicate the resection region. Our RATE technique has proven to be clinically effective and safety.

Massive and supramassive splenomegaly are relative contraindications to pure laparoscopic splenectomy (LS). A retrospective review of adult patients was conducted for splenectomy occurring from 1999 to 2009. Massive and supramassive spleens were defined as craniocaudad length ≥ 17 cm or weight ≥ 600 g and craniocaudad length ≥ 22 cm or weight ≥ 1,600 g, respectively. LS was done for 22 and open splenectomy for 21 patients, of which 12 and 14 were supramassive. Spleen weight and craniocaudad length were comparable. LS was associated with lower blood loss (308 vs 400 mL, P = .24), shorter length of stay (3 vs 4.5 days, P = .054), and similar morbidity (17% vs 14%). Two reoperations and 1 death occurred with open splenectomy. Operative times were longer for LS (195 vs 105 min, P = .008), while the conversion rate was 25%. In cases of massive and supramassive splenomegaly, better outcomes are accomplished with LS than open splenectomy, and are comparable to hand-assisted LS.

Background This study was designed to compare the laparoscopic subtotal splenectomy with the robotic approach in patients with hereditary spherocytosis. Methods Thirty-two consecutive subtotal splenectomies by minimal approach in patients with hereditary spherocytosis were analyzed (10 robotic vs. 22 laparoscopic subtotal splenectomies). Results A significant difference was found for the robotic approach regarding blood loss, vascular dissection duration, and splenic remnant size. Follow-up for 4–103 months was available. Conclusions Subtotal splenectomy seems to be a suitable candidate for robotic surgery, requiring a delicate dissection of the splenic vessels and a correct intraoperative evaluation of the splenic remnant. Robotic subtotal splenectomy is comparable to laparoscopy in terms of hospital stay and complication. The main benefits are lower blood loss rate, vascular dissection time, and a better evaluation of the splenic remnant volume.

Objective: We describe our experience of single-incision laparoscopic splenectomy (SILS) for an unruptured aneurysm of the splenic artery. Clinical Presentation and Intervention: A 73-year-old woman was diagnosed as having a splenic aneurysm which grew from 14 to 22 mm in diameter within 2 years. Due to a contrast agent allergy, transcatheter arterial embolization could not be performed; therefore, SILS was performed with a 4-cm Z-shaped incision. The operative time and intraoperative blood loss were 132 min and 27 mL, respectively. The patient was discharged 4 days after surgery. Conclusion: In selected cases, SILS is a suitable and safe procedure for an unruptured aneurysm of the splenic artery.

Clinical manifestations of hereditary spherocytosis can be controlled by splenectomy. The use of this procedure has been restricted due to concerns regarding exposure of patients to a lifelong risk of overwhelming infections. Subtotal splenectomy, which removes 85-90% of the enlarged spleen, is a logical alternative. In the first cases performed by laparoscopy we have chosen to preserve the upper pole. However, this technique showed some disadvantages, especially concerning the correct intraoperative evaluation of the splenic remnant volume. Therefore, we developed a new variant of the procedure by preserving the lower pole of the spleen. Based on the authors' experience in laparoscopy (176 laparoscopic splenectomies), 10 laparoscopic subtotal splenectomies were performed in patients with hereditary microspherocytosis, preserving either the upper or the lower splenic pole. Patient age ranged between 5 and 35 years. The mean volume of the remnant spleen was 41.4 cm3. There were no complications, and no transfusions were needed. Follow-up for 1-30 months was available. Subtotal splenectomy appears to control hemolysis while maintaining splenic function. The laparoscopic approach is safe and effective and should be considered the procedure of choice in hereditary microspherocytosis. Laparoscopic subtotal splenectomy presents an advantage over open subtotal splenectomy, resulting in decreased blood loss, shorter hospital stay, no conversions, fewer operative and postoperative complications, and excellent remission rates. On the basis of our experience, the preservation of the lower pole of the spleen seems to be a first-line option for the optimal evaluation of the residual splenic mass.

BackgroundPrimary splenic involvement is an uncommon manifestation of hydatid disease. Partial laparoscopic splenectomy can be performed with lower risks and good hematological results by preserving the immunological function of the spleen. The aim of this study was to outline the advantages of robotic partial splenectomy as a treatment for splenic hydatid cysts.Materials and methodsFour patients with splenic hydatidosis were treated by robotic approach. The patients included one man and three women, with a mean age of 24 years (range 16–34). The localization was in the upper pole in one case and voluminous cysts in the hilar region in the other three.ResultsRobotic hemisplenectomy was performed in the upper pole localized cyst and robotic subtotal splenectomy with lower pole preservation in the other three. The mean operative time was 120 min (±37 min) with a console time of 95 min (±28 min); the mean hospital stay was 5 days (±2 days).ConclusionPartial robotic splenectomy seems to offer safety and all benefits of minimally invasive surgery, preserves the immune function of the spleen and allows the surgeon to conserve as much of the splenic parenchyma as possible.

Abstract Splenectomy can be performed using various surgical approaches, including open, laparoscopic (LS), and robotic splenectomy (RS). While LS has been the mainstay for many years, it is associated with a steep learning curve and increased rates of morbidity and conversion to open surgery in complex cases such as splenomegaly, obesity, haematological malignancies, and patients with prior laparotomies. RS has emerged as a technique that facilitates a spleen-focused dissection, potentially reducing anatomical disruption and operative risk. This systematic review aimed to compare the peri-operative outcomes of LS and RS in non-traumatic indications for splenectomy. A comprehensive search was conducted in MEDLINE, Embase, CINAHL, and CENTRAL databases, along with searches for unpublished and ongoing studies through the World Health Organization platform. Data extraction was standardized using a pre-tested collection form, and statistical methods were employed to derive mean values where only medians and interquartile ranges were reported. The results demonstrated that the mean operative time was longer in the RS group, although the difference was not statistically significant. Conversion to open surgery occurred in 12 LS cases compared to 2 RS cases. Post-operative complications were more frequent in the LS group (9 patients) compared to the RS group (1 patient), with most complications observed after 24 hours. The mean length of hospital stay was similar between groups (6.0 days for RS vs. 6.5 days for LS; P = 0.89). RS was associated with lower mean intraoperative blood loss compared to LS. In conclusion, RS may offer advantages over LS in terms of reduced blood loss, lower conversion rates, and fewer postoperative complications, although it does not significantly impact hospital stay duration or cost-effectiveness and is associated with longer operative time.

Introduction Laparoscopic splenectomy is increasingly performed in pediatric patients due to its well-established advantages over open surgery. However, specialized commercial retrieval bags used for specimen extraction add to procedural cost and may not be readily available in resource-limited settings. This study evaluated the feasibility and safety of a handmade retrieval pouch fashioned from a sterile diathermy pouch for pediatric laparoscopic splenectomy. Methods The study included 25 children aged 3 to 15 years who underwent elective laparoscopic splenectomy for benign hematologic disorders. A retrieval pouch was prepared from a sterile diathermy pouch supplied as part of the disposable sterile towel set. After spleen enclosure, the pouch opening was closed with a running suture and exteriorized through the umbilical incision for controlled in-bag fragmentation and extraction. The primary outcome was successful specimen retrieval without bag failure or conversion. Results The technique was successfully utilized in all 25 cases with no intraoperative complications. Spleen size ranged from 12 to 22 cm. Mean retrieval time was 36 min, decreasing from 120 min in the first case to 33 min in subsequent cases. Larger spleens (> 16 cm) required longer extraction times (47.0 ± 10.6 vs. 25.0 ± 2.7 min, p  < 0.001). Patients experienced rapid recovery (mean hospital stay 1.7 ± 0.8 days) and excellent outcomes, with 92% reporting maximum satisfaction with cosmetic results and no postoperative complications at 3-month follow-up. Conclusion In this preliminary series, use of a retrieval bag fashioned from a repurposed sterile diathermy pouch was feasible and safe for pediatric laparoscopic splenectomy across a broad range of splenic sizes, without additional incisions or retrieval-related complications.

IntroductionSplenectomy has been used as a diagnostic and therapeutic tool in the management of hematological diseases for many years. However, the emergence of new medical therapies has modified guidelines for many hematological diseases for which splenectomy was previously considered. We aimed to evaluate the evidence of a decrease in the hematological indications for splenectomy and the reasons and justifications for this change.Material and methodsWe conducted a single-center, retrospective analysis of patients who underwent laparoscopic splenectomy for hematological disease between January 2010 and December 2023. Patients were classified into four groups: 1 autoimmune and hemolytic diseases (HAD), (2) lymphomas, (3) myeloproliferative diseases (MPN), and (4) other splenic diseases. We recorded the annual incidence of splenectomy and the ratio of new medical cases, demographic and clinical data and surgical outcomes.ResultsDuring the study period, 98 patients were referred for splenectomy. There was a significant progressive decrease in this surgical indication, particularly regarding HAD (p < 0.001). The indication for splenectomy for immune thrombocytopenic purpura (ITP) declined to zero despite an increase in the number of patients diagnosed with this disorder (p < 0.001). The pattern of decrease in AHAI and Evans syndrome was similar to that in ITP. The group of splenectomies due to lymphoma persisted consistently during the study period, as did the indication for splenectomy in the context of lymphoma treatment. Splenectomy due to massive splenomegaly secondary to MPN was indicated only in one patient. Splenectomies due to other causes were similarly distributed over the years.ConclusionsOur findings confirm a significant decrease in the indication for elective surgery for hematological diseases, mainly regarding autoimmune disease. The surgical community and surgical departments should be aware of this situation yet maintain the skills to adopt this technique both safely and efficiently.

BackgroundThe benefits of laparoscopic splenectomy (LS) over open splenectomy (OS) for normal-sized spleens have been well documented. However, the role of laparoscopy for moderate and massive splenomegaly is debated.MethodsA retrospective review of patients undergoing elective splenectomy at one institution from 1997 to 2017 was conducted. Moderate and massive splenomegaly was defined as splenic weight of 500–1000 g and greater than 1000 g, respectively. We performed a 1:2 matching of laparoscopic to open splenectomy to control for differences in splenic weight. Differences in perioperative morbidity (infection, thromboembolism, reoperation, readmission), intraoperative factors (blood loss, operative time), length of stay, and mortality were examined.ResultsA total of 491 elective splenectomies were identified. 268 cases were for splenic weights greater than 500 g. After a 1:2 matching of LS:OS, we identified 22 LS and 44 matched OS for moderate splenomegaly. The LS group had longer mean operative times (178 vs. 107 min, p < 0.01), with similar length of stay and blood loss. For massive splenomegaly, 26 LS were identified and matched to 52 OS. LS had longer mean operative times (171 vs. 112 min, p < 0.01) and higher readmission rates (27% vs. 6%, p < 0.05). Other factors and outcomes did not differ between LS and OS for moderate or massive splenomegaly. The conversion rate for LS was higher for massive versus moderate splenomegaly, but was not statistically significant (35% vs. 14%, p = 0.09).ConclusionsLS for moderate and massive splenomegaly is associated with longer operative times. Other perioperative outcomes were comparable to OS, with no demonstrated benefits for LS. Although LS may be a feasible approach to moderate and massive splenomegaly, its benefits require further clarification in this patient population.