Early experience with robotic splenectomy for massive and supramassive splenomegaly

Minimally invasive splenectomy has been associated with improved perioperative outcomes compared with open splenectomy, but its application to massive and supramassive spleens has historically been limited. While laparoscopic splenectomy is feasible, the growing adoption of robotic-assisted laparoscopic splenectomy raises questions about its benefits. We hypothesized that robotic-assisted laparoscopic splenectomy would be feasible for massive and supramassive splenomegaly, superior to open splenectomy, and potentially advantageous over laparoscopic splenectomy.

A single-institution retrospective review was performed of patients undergoing splenectomy from 2012 to 2024. Patients <18 years or with trauma, variceal bleeding, or major concurrent procedures were excluded. Splenic size was defined by craniocaudal length as normal (<14 cm), massive (14-22 cm), or supramassive (>22 cm). Primary endpoints included perioperative complications (Clavien-Dindo) and length of stay.

One hundred six patients (81 laparoscopic splenectomy, 18 robotic-assisted laparoscopic splenectomy, and 7 open splenectomy) were included. Compared with open splenectomy, both laparoscopic splenectomy and robotic-assisted laparoscopic splenectomy had a reduced length of stay and estimated blood loss. Robotic-assisted laparoscopic splenectomy was associated with the shortest length of stay, no readmissions, no conversions, and no mortality. Compared with laparoscopic splenectomy, robotic-assisted laparoscopic splenectomy had reduced hand port use. Postoperative complication rates were similar between approaches. Though robotic-assisted laparoscopic splenectomy was associated with the longest operating time, recent cases showed comparable times to laparoscopic splenectomy.

Robotic-assisted laparoscopic splenectomy represents a feasible approach to splenectomy, even for massive and supramassive spleens. The superior visualization and instrumentation of robotic-assisted laparoscopic splenectomy may afford a larger number of surgeons safe access to minimally invasive approaches, even for these difficult cases, and thereby spare immunocompromised and high-risk patients the morbidity of an open splenectomy.