Robot-Assisted Laparoscopic Splenectomy In Children: A Case Report with Literature Review

Summary

Here, we present a case of robotic-assisted splenectomy for pediatric hereditary spherocytosis.

Abstract

In March 2025, a pediatric patient diagnosed with hereditary spherocytosis (HS) was admitted to the Department of Gastrointestinal Surgery at Xiangyang Central Hospital, affiliated with Hubei University of Arts and Sciences. A total robotic splenectomy was elected as the definitive surgical intervention. The procedure was successfully executed, with a total operative time of 145 min. This duration was strategically allocated, comprising 35 min for the initial system docking, followed by 110 min of efficient console time for splenic dissection and removal. A key highlight of the operation was its exceptional hemostatic control, with an estimated blood loss of merely 2 mL, underscoring the precision afforded by the robotic platform. Postoperative ultrasonographic evaluation of the abdomen, liver, and spleen revealed no significant abnormalities. This case suggests that robotic-assisted surgery using the Da-Vinci platform is a feasible approach for a pediatric patient with hereditary spherocytosis requiring spleen resection, providing valuable technical insights for similar procedures in children.

Introduction

Hereditary spherocytosis is an inherited disorder affecting erythrocyte membrane proteins (including proteins ankyrin, band 3, β spectrin, α spectrin, or protein 4.2), ultimately resulting in a lack of membrane surface area¹. Due to the inherent defects of the membrane of spheroid erythrocytes, they are easily retained and destroyed in the spleen. The clinical manifestations are anemia, jaundice, and splenomegaly, and hemolytic crisis may occur in acute attacks. Jaundice and anemia usually disappear in a short period after splenectomy, and anemia can be completely and permanently corrected². For patients requir....

Protocol

This protocol was approved by the Clinical Research Ethics Committee of the Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Sciences. Written informed consent was obtained from the patient.

1. Preoperative preparations

1. Have the patient fast for a period of 6 h prior to the procedure, and have the patient abstain from drinking for a further 2 h. In addition, administer prophylactic antibiotics.

2. Patient positioning and trocar placement

1. Following the success of the anesthesia, position the patient in the lateral decub....

Results

Total operative time was 145 min (docking: 35 min; console: 110 min) with estimated blood loss of 2 mL. The patient maintained hemodynamic stability throughout the perioperative period. On postoperative day 1, pyrexia (38.6 °C max) resolved with intravenous cefoperazone and acetaminophen. Flatus was observed on postoperative day 2. A liquid diet was initiated on postoperative day 3. The abdominal drainage tube was removed on postoperative day 4. A blood test rechecked on postoperative day 3 revealed an increase in platel.......

Discussion

Hereditary spherocytosis (HS) is a prevalent autosomal dominant hemolytic disorder characterized by spherical erythrocytes in peripheral blood. These microspherocytes undergo splenic sequestration and extravascular hemolysis, resulting in chronic anemia and unconjugated hyperbilirubinemia. Splenectomy remains the definitive management for symptomatic HS, with resolution of hemolytic parameters postoperatively¹. According to established clinical guidelines, splenectomy is not indicated for patients.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Absorbable ligature clip	Hangzhou KANGJI Medical Instrument co., LTD	KJ-JZJ02ML
Fenestrated bipolar forceps	Intuitive Surgical	471205
Leonardo Da Vinci surgical robot	Intuitive Surgical	Xi system
Permanent Cautery Hook	Intuitive Surgical	3519
Ultrasound knife	INNOLCON, Medical Science and Technology (suzhou) co., LTD	N/A