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

Since the first laparoscopic splenectomy in 1991, splenic surgery has evolved steadily toward minimally invasive techniques, which now represent the gold standard for most indications. In children, the principal indications remain hemolytic disorders, mainly sickle cell disease and hereditary spherocytosis, for which the optimal timing of surgery and the choice between partial and total splenectomy continue to be debated. Two laparoscopic approach, anterior and posterior, are described, each dictating a specific patient position, dissection sequence, and trocar placement. Teaching the procedure is facilitated by dividing it into defined operative steps, distinguishing "fast steps," which are technically straightforward and reproducible, from "slow steps," which demand caution and should be taught only once the trainee is proficient. Adhering to a fixed sequence helps prevent complications. The two principal postoperative complications, acute chest syndrome and post-splenectomy infection, are reviewed. Shorter operative times and inadequate mobilization of the pancreatic tail appear associated with acute chest syndrome. Contemporary French national data confirm that a substantial proportion of splenectomy, roughly one-fifth of total and nearly one-third of partial procedure, are still performed open, underscoring that open surgery remains indispensable for emergency hemostasis, malignancy, massive splenomegaly, and conversion of a minimally invasive operation. Yet training now focuses almost exclusively on minimally invasive techniques, while robotic platforms raise the further question of whether robotic splenectomy should be taught to trainees who have never performed an open procedure. Modern pediatric surgical training must therefore remain comprehensive and structured, preserving fundamental open skills alongside laparoscopic and robotic proficiency.