Splenectomy training in 2026: A modest proposal for the thoroughly confused surgeon

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Surgical Training

Background:

• Laparoscopic splenectomy, first performed in 1991, has become the gold standard for most indications.
• In children, primary indications include hemolytic disorders like sickle cell disease and hereditary spherocytosis.
• Debate continues regarding optimal surgical timing and the choice between partial and total splenectomy.

Purpose of the Study:

• To review the evolution and current status of laparoscopic splenectomy in children.
• To describe laparoscopic approaches, operative steps, and teaching strategies.
• To discuss postoperative complications and the role of open surgery in modern training.

Main Methods:

• Description of anterior and posterior laparoscopic approaches, including patient positioning and trocar placement.
• Division of the procedure into "fast" and "slow" steps for training purposes.
• Review of postoperative complications, specifically acute chest syndrome and post-splenectomy infection.

Main Results:

• Laparoscopic techniques are now standard, but open surgery remains essential for specific scenarios (hemorrhage, malignancy, massive splenomegaly).
• Contemporary data show a significant proportion of splenectomies are still performed open.
• Shorter operative times and inadequate pancreatic mobilization are linked to acute chest syndrome.

Conclusions:

• Modern pediatric surgical training must integrate minimally invasive techniques with fundamental open surgical skills.
• The role of robotic platforms in training requires further consideration.
• Comprehensive training is crucial to address the evolving landscape of splenectomy procedures.