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

A 7-year-old girl with hereditary spherocytosis underwent robot-assisted laparoscopic splenectomy using the da Vinci system, achieving minimal blood loss and stable recovery. This case demonstrated extremely low intraoperative blood loss of two milliliters and successful robotic splenectomy despite limited pediatric abdominal working space. After preparing the patient and creating an optical access port, pneumoperitoneum was established using a Veress needle with the intraabdominal pressure maintained at 10 millimeters of mercury.

Trocars of appropriate sizes were subsequently placed, one at the right upper abdomen between the midclavicular line and the midline at the umbilical level, one along the left anterior axillary line at the umbilical level, and one through a 1.2-centimeter incision in the left lower abdomen to serve as an auxiliary port. The robotic arms of the surgical system were subsequently docked. An electrocautery hook, bipolar forceps, and an ultrasonic scalpel were inserted through the trocars.

The gastrosplenic ligament was divided with an ultrasonic scalpel and the short gastric vessels and superior polar vessels of the spleen were successively ligated and transected. The adhesions between the pancreatic tail and the lower splenic pole were carefully dissected using an electrocautery hook, and the splenocolic ligament was divided. After exposing the splenic pedicle vessels along the superior border of the pancreas, suture ligation was performed, followed by Hem-o-lok clip application and vessel transection.

The splenophrenic and splenorenal ligaments were subsequently divided with care taken to avoid injury to the splenic hilum and the pancreatic tail. Then the spleen was completely mobilized. After placement in a specimen retrieval bag, the spleen was morcellated and extracted in pieces through the umbilical incision.

All resected specimens were sent for histopathological analysis. Following splenectomy, the abdominal cavity was thoroughly inspected. After confirming hemostasis, particularly at the splenic bed, pancreatic tail, and along the greater curvature of the stomach, a closed suction drain was placed in the splenic fossa under laparoscopic guidance.

Finally, the robotic arms and trocars were withdrawn and the abdominal wall was closed in layers. The 7-year-old girl with hereditary spherocytosis successfully underwent the robot-assisted surgery. The total operative time was 145 minutes, including 35 minutes for docking and 110 minutes for console time.

On postoperative day one, pyrexia with a maximum temperature of 38.6 degrees Celsius was observed and later resolved with intravenous Cefoperazone and acetaminophen administration. Flatus was observed on postoperative day two. A liquid diet was initiated on postoperative day three.

The abdominal drainage tube was removed on postoperative day four. A blood test performed on postoperative day three revealed an increase in platelet count. Dipyridamole was administered at a dose of three milligrams per kilogram per day for treatment, and blood counts were monitored dynamically to ensure normalization.

Limited pediatric abdominal space and risk of pancreatic injury were managed using precise robotic articulation, careful dissection, and optimized trocar placement. Postoperative recovery was uneventful with normalized hematologic parameters and no complications at three month follow-up evaluation.