Robotic Cystectomy For A Ruptured Large Splenic Cyst

A 19-year-old male from Mumbai ruptured a large splenic cyst while playing football. He was taken to the emergency room of a nearby hospital and then shifted to a big corporate hospital. He was stabilised and advised of Splenectomy by various consultants but did not get treatment option for spleen preservation in Mumbai. The patient consulted doctors at Max Super Speciality Hospital, Patparganj, over the telephone. The doctors gave the option of minimally-invasive Cystectomy with splenic preservation using Robotic Surgery.

The patient flew to Delhi and got admitted at Max Hospital, Patparganj, under the Institute of Minimal Access, Bariatric & Robotic Surgery. His CT scan suggested a huge splenic cyst of size 10.8 x 9.5 x 8.6 cm abutting the diaphragm, pancreas and stomach.
The biopsy indicated a benign epithelial cyst.

It was a challenge to preserve the spleen and still remove the cyst, as the spleen is a very vascular organ and can bleed profusely on the division of parenchyma. Splenic preservation is desirable as it is an important immune organ. Splenectomy can lead to OPSI (Overwhelming Post Splenectomy Infection), which has a high mortality. For a young patient, preserving the spleen becomes vital in order to enable him to resume his normal work.

Post-operative period was uneventful. The patient was mobilised and given a liquid diet on the same day of surgery. He was discharged on post-operative day two and flew back to his hometown on day fourth of his surgery.

The patient was taken up for surgery, and da Vinci Xi Robotic System was used. A large cyst was found over the upper pole of the spleen, which was densely adherent to surrounding tissue. Adequate precautions were taken to prevent spillage of cyst contents and avoid anaphylaxis. The entire cyst was removed, and the spleen was preserved. Intra-operative blood loss was 10-20 ml.