Robot-Assisted Treatment of Splenic Artery Aneurysm with Spleen Preservation: Aneurysmectomy and Vascular Reconstruction

Aim: Robotic surgery can extend the indication of minimally invasive surgery in challenging procedures. In particular it can overcome laparoscopic limitation in controlling vessels and performing vascular anastomosis. We are presenting a case of a robot-assisted splenic artery aneurysmectomy with vascular reconstruction and spleen preservation with the use of the da Vinci Si. Methods: A 67-years old man with an asymptomatic aneurysm of the distal tract of the splenic artery was referred to our center. The 3-cm aneurysm was incidentally detected by abdominal ultrasound and confirmed by CT scan. The patient was operated with the use of the da Vinci Si surgical system and was placed in a right sided position. Results: The aneurysmectomy was easily carried out, despite the presence of intense adhesions with the tail of the pancreas. A vascular end-to-end anastomosis was performed, with 5/0 interrupted of gore-tex sutures allowing the spleen preservation. The final view of the spleen confirmed the correct revascularization. The procedure was successfully completed in 170 min. No intra-operative complications were recorded. The postoperative course was uneventful and the patient was discharged four days after surgery. An abdominal ultrasound scan showed a normal flow in the splenic artery. Conclusions: In our experience, robot-assisted treatment of splenic artery aneurysm is feasible and safe and it results to be an important option for the treatment of this disease. The enhanced surgical dexterity offered by robot da Vinci allows a fine and accurate vascular dissection and suturing. It permits spleen preservation by using a minimally invasive technique.