Robotic Treatment of Splenic Diseases

Robotic splenectomy with da Vinci Xi is a novel approach to the treatment of splenic benign and malignant disorders and arterial aneurisms. Robot’s advantages consist in endowristed instruments with a stable 3d view and a 4 × zoom that allow a more meticulous hilar dissection especially in most complex cases (magistral pattern, intrasplenic pancreatic tail, high spleen volume, fragile parenchyma) and in cases of vascular reconstruction. Da Vinci Xi allows also the use of high energy device like Synchoseal or Harmonic ACE and this in useful in hemisplenectomy. In operative room the patient cart is docked from the patient’s right side, with the boom rotated to target the left upper quadrant and after inducing pneumoperitoneum assistant port is placed above the umbilicus near midline. The 4 robotic ports are placed as described in Fig. 33.3. In anterior approach after sectioning the gastrocolic and phrenicocolic ligament splenic hilum is identified and isolated. Splenic vein is sectioned at first and then splenic artery. Splenectomy is completed sectioning the peritoneal lateral and posterior ligaments. Then specimen is extracted in Endobag with a Pfannestiel incision. Usually the indications for the treatment of SAA include symptomatic aneurysms and asymptomatic aneurysms >2 cm. The aneurysm is resected with robotic scissors and the splenic artery reconstructed by a double running suture using PTFE 5-0 sutures.