Partial robotic splenectomy in hydatid disease

Abstract

Dear Editor, I read a recent report by Vasilescu et al. with great interest [1]. Vasilescu et al. concluded that “Partial robotic splenectomy seems to offer safety and all benefits of minimally invasive surgery, preserves the immune function of the spleen and allows the surgeon to conserve as much of the splenic parenchyma as possible [1].” I agree that partial robotic splenectomy might be a good alternative approach in splenic surgery. However, the appropriateness for cases with hydatid cyst should be discussed. Culafic et al. reported that “Spleenpreserving surgery should be undertaken if possible in patients with spleen echinococcosis, and total splenectomy is reserved for the patients with large cysts located centrally or near the hilus [2].” The main problems of robotic splenectomy might be the recurrence of parasitic cyst or incomplete removal. In addition, if there is extrasplenic cyst, the problematic cysts might be neglected. Open surgery might be more appropriate since all gross pathology can be more clearly examined. Indeed it is proposed that “Open partial splenectomy is a safe and effective method in the management of nonparasitic splenic cysts. It ensures complete cyst removal, lack of cyst recurrence, and preservation of the spleen functions [3].” Hence, the preservation of splenic function can still be derived in open surgery.