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Simultaneous Robotic-Assisted Splenectomy and Cholecystectomy in Children: Is It Safe and Effective?
Carlos Delgado-Miguel1,2, Juan I Camps1
1Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, South Carolina, USA.
Insights
Robotic-assisted splenectomy and cholecystectomy are safe for children with blood disorders affecting the spleen and gallbladder. This combined procedure shows minimal complications and short hospital stays, offering a viable surgical option.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Hematology
Background:
- Hematologic conditions like hereditary spherocytosis and sickle cell disease are linked to gallbladder issues (cholelithiasis).
- Symptomatic patients often require simultaneous spleen and gallbladder removal (splenectomy and cholecystectomy).
Purpose of the Study:
- To evaluate the outcomes of robotic-assisted simultaneous splenectomy and cholecystectomy in pediatric patients with hematologic diseases.
- To assess the safety and feasibility of this combined surgical approach.
Main Methods:
- Retrospective study of 11 pediatric patients (ages 8-17) from January 2010 to December 2021.
- Patients underwent combined robotic-assisted splenectomy and cholecystectomy using the da Vinci Surgical Si System.
- Analysis included demographics, operative data, hospital stay, complications, and follow-up outcomes.
Main Results:
- Hereditary spherocytosis (7 cases) and sickle cell disease (4 cases) were the primary diagnoses, all with symptomatic cholelithiasis.
- Median surgery time was 145 minutes with minimal blood loss (mean 45 mL).
- No intraoperative complications, conversions, wound infections, or postoperative bleeding were reported. Median hospital stay was 3 days.
Conclusions:
- Simultaneous robotic-assisted splenectomy and cholecystectomy are safe and feasible for pediatric patients with relevant hematologic conditions.
- The procedure demonstrates low complication rates and efficient recovery.
- Further research is recommended to standardize this approach and expand evidence.
Abstract:
Hematologic conditions such as hereditary spherocytosis, sickle cell disease, and idiopathic thrombocytopenic purpura are frequently linked to cholelithiasis. In instances where symptoms are present, simultaneous cholecystectomy and splenectomy are commonly recommended. Our aim was to assess the outcomes of robotic-assisted procedures conducted for simultaneous surgical issues involving the spleen and gallbladder in pediatric patients. We have made a simultaneous retrospective study of children with hereditary hematological diseases who underwent combined robotic-assisted splenectomy and cholecystectomy at our institution from January 2010 to December 2021. Demographics, clinical features, intraoperative data, length of hospital stay, postoperative complications, and follow-up outcomes were analyzed. A total of 11 patients (6 male; 5 female) were included, with a mean age of 13.9 ± 4.4 years (range 8-17). Hereditary spherocytosis was the most common disease (7 cases), followed by sick cell disease (4 cases), with associated symptomatic gallbladder litiasis in all of them. Both operations were carried out using the da Vinci® Surgical Si System in a single docking robotic platform (four robotic arms). Median total surgery time was 145 minutes (Q1-Q3: 115-162). Minimal intraoperative bleeding was recorded (mean 45 ± 15 mL), with no intraoperative complications or conversion. Median length of hospital stay was 3 days (Q1-Q3: 2-4). There were no cases of surgical wound infections or postoperative bleeding documented. Simultaneous robotic-assisted splenectomy and cholecystectomy can be considered safe and feasible interventions in children with hematological diseases that affect both the spleen and the gallbladder. However, further research is needed to enhance the existing evidence and establish a standardized approach.
