title: Robotic splenectomy with ex vivo bench surgery and hemi-spleen autotransplant: the first report.
abstract: BACKGROUND
  We describe our experience with what is, to our knowledge, the first case of robotic assisted ex vivo partial splenectomy with auto-transplantation for a benign non parasitic cyst.
  
  
  METHODS
  The patient is a 32 year-old female with a giant, benign splenic cyst causing persistent abdominal pain. Preoperative imaging showed a cystic lesion measuring 8.3 × 7.6 cm, in the middle portion of the spleen. Due to the central location of the bulky lesion a partial splenectomy was not feasible. As an alternative to a total splenectomy, a possible reimplantation of hemi-spleen after bench surgery was offered. We proceeded with a robotic total splenectomy and bench hemisplenectomy, preserving the lower pole and a portion of the middle segment of the organ. A robotic reconstruction of the splenic vessels was then performed intra-abdominally. The reperfusion was optimal.
  
  
  RESULTS
  The total operative time was 305 min, with 78 min of robotic time. Postoperative ultrasound confirmed a patent arterial and venous flow. The postoperative course was uneventful and the patient was discharged on postoperative day 4. The pathology report was consistent with epithelial cyst of the spleen. The patient is doing well at 6-month follow-up.
  
  
  CONCLUSIONS
  The optimized vision and dexterity provided by the robotic system allowed a safe and precise reconstruction of the splenic vessels, even in a deep and narrow operative field. Partial splenectomy with autotransplantation of the organ was thus achieved, avoiding a total splenectomy in a young patient.
authors: Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood St, Chicago, IL, 60612, USA.
authors: Pier Cristoforo
authors: PC
authors: Giulianotti
authors: Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood St, Chicago, IL, 60612, USA.
authors: Despoina
authors: D
authors: Daskalaki
authors: Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood St, Chicago, IL, 60612, USA. lfgoncicca@gmail.com.
authors: Luis F
authors: http://orcid.org/0000-0001-9381-6583
authors: LF
authors: Gonzalez-Ciccarelli
authors: Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood St, Chicago, IL, 60612, USA.
authors: Francesco M
authors: FM
authors: Bianco
mesh_terms: D000328:Adult; D064592:Autografts; D003560:Cysts / Q000601:surgery*; D005260:Female; D006801:Humans; D065287:Robotic Surgical Procedures / Q000379:methods*; D013154:Spleen / Q000601:surgery / Q000637:transplantation*; D013156:Splenectomy / Q000379:methods*; D013158:Splenic Diseases / Q000601:surgery*
keywords: Autotransplant; Case report; Ex vivo surgery; Hemi-spleen; Partial splenectomy; Robotic splenectomy