WOFAPS 2025 8th World Congress of Pediatric Surgery

Qingjiang Chen, Yuebin Zhang, Duote Cai, Wenjuan Luo, Linyan Wang, Zongwei Huang, Shuhao Zhang, Xiaoxiao Xuan, Qixing Xiong, Zhigang Gao

Children's Hospital, Zhejiang University School of Medicine

Abstracts

Purpose: Benign splenic lesions are relatively rare, and partial splenectomy is still difficult in children. The aims of this study were to explore the safety and effectiveness of robotic assisted partial splenectomy in treatment of benign splenic lesions in children.

Methods: We conducted a retrospective analysis of the records of all children diagnosed with benign splenic lesion and underwent robotic assisted partial splenectomy admitted to our center between April 2020 and December 2024. We analyzed demographic criteria, clinical manifestations, imaging examinations, surgical details, postoperative complications, and final outcomes.

Results: Among the 20 patients, there were 12 males and 8 females, with age range from 4.92 to 15.25 years (means 10.87±2.91 years). Two patients had intermittent abdominal pain, three patients with splenic cysts complicated infection and one of them underwent delayed surgical resection after external drainage of the cyst, and the remaining 15 cases were accidentally diagnosed by ultrasound examination. The maximum diameter of the lesion ranged from 4.5 to 17.5cm (means 7.37±3.32cm), with 9 cases located at the upper or middle upper pole of the spleen and 11 cases located at the lower or middle lower pole of the spleen. All patients underwent robotic assisted partial splenectomy without conversion to open surgery. Four cases of lesions beyond the upper or lower pole of the spleen were performed superselective splenic vascular ligation; three cases underwent main splenic artery ligation due to massive lesions, while preserving the gastric short blood vessels and splenic diaphragmatic ligament. The operation time was 95-239 minutes (means 163.69±47.36 minutes), and the intraoperative bleeding was 10-500ml (median 20ml). Postoperative pathology revealed 10 cases of splenic cysts, 5 cases of lymphangioma, 2 cases of hamartoma, 1 case of splenic hemangioma, sclerosing angiomatoid nodular transformation and splenic Littoral cell angioma respectively. There were no postoperative complications of bleeding, splenic ischemia, intra-abdominal infection, intestinal adhesion, and severe infection. No tumor recurrence was observed during the follow-up period of 1 month to 4 years.

Conclusions: Partial splenectomy is safe and reliable for the treatment of benign splenic lesions in children. For lesions beyond the upper and lower poles of the spleen, partial splenic parenchyma can also be preserved through superselective splenic vessel ligation or complete dissection of the main splenic artery. Robot assisted partial splenectomy can significantly shorten surgical time and reduce intraoperative bleeding, making it more suitable for pediatric partial splenectomy.