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A clinical case of a 56-year-old man with a voluminous calcified splenic cyst of almost 10 cm, suspected to be a hydatid cyst, is presented. After showing CT images confirming the diagnosis and the size of the lesion, a robotic splenectomy is decided upon. The surgical team proceeds with the preparation of the operative field, marking the access points on the patient's abdomen. Subsequently, pneumoperitoneum is created using the Veress needle, and trocars are placed. The intervention continues with the introduction of the laparoscope and the docking of the DaVinci robotic surgical system. The actual surgical phase begins with the colo-epiploic dissection to expose the spleen, using instruments like the Vessel Sealer for hemostasis. During the procedure, a small bleeding is managed with the aid of gauze, before continuing the dissection.
AI-translated from Italian
0:09
So, now we are preparing for a robotic splenectomy.
0:15
Sauro, if you go to the next slide, please.
0:18
So, this is a 56-year-old man who comes to us for the finding of a splenic cyst.
0:30
In his medical history, an umbilical hernioplasty, an amputation of the second finger of the right hand,
0:36
benign prostatic hypertrophy for which he underwent an MRI, send the next slide Sauro
0:43
please, in which this cyst was found compressing the gastric body, so he had
0:52
a CT scan that confirmed this splenic cyst of almost 10 cm, calcified, compatible with a
1:02
hydatid cyst. He had serology done which was negative, but the infectious disease specialist for
1:08
due to the suspicion derived from the images, decided to have him undergo preoperative prophylaxis with albendazole.
1:20
The cyst is very large, occupying almost the entire volume of the upper pole of the spleen,
1:27
therefore, surgical indication was given.
1:30
This is the lesion you see in the images.
1:34
and therefore the indication for robotic splenectomy
1:41
now you see Dr. Giraldi and Dr. Vilardo
1:47
positioning the trocars for the splenectomy
1:52
we use a slightly oblique supraumbilical line
1:59
thus targeting the splenic hilum
2:03
So, excuse me, hello, welcome back. But was the patient asymptomatic? Was it an incidental finding?
2:22
Let's say he had dyspepsia which he had never actually associated with this formation because he didn't know he had it.
2:31
The imaging finding was due to another examination he had for prostatic hypertrophy, which then led to this diagnosis.
2:44
In reality, beyond the dyspepsia that no one had correlated with such a thing, it is mostly very, very voluminous.
2:57
The patient, fundamentally, beyond the discomfort, the compression on the gastric body, is strongly motivated to undergo splenectomy also due to the risk of rupture.
3:09
Excuse me, what was his occupation? What did he do?
3:19
Well, he's an entrepreneur, but he doesn't have dogs, and it's unknown how he could have contracted this echinococcus.
3:33
For the infectious disease specialist, it's a rare but possible localization. Did you hear me?
3:52
Perfectly, thank you, nice to meet you, I'm Mariani, we spoke this morning with my colleague.
7:48
Now do you see?
7:52
The view is a bit lateral here, but definitely better than before, okay.
7:58
I'm Masetti, just to help you understand, the trocar placement is very similar to that for distal splenopancreatectomy resection. We are used to placing the optical trocar first because if we made a mistake in our predictions,
8:34
we are too close or too far, with the optical zoom we can correct and bring the instrument line
8:43
a little further forward or a little further back, not by much but a minimum can be corrected.
8:47
That's why we always enter with the first trocar, the optical one, after performing pneumoperitoneum with the Veress needle.
12:58
Has the patient's position also changed, right?
13:01
Yes, also postoperative pain, as well as abdominal pressure.
13:12
Did you change the patient's position anyway, did you rotate him?
13:16
No, we are, he is in anti-Trendelenburg, right lateral, 15 degrees.
14:52
We didn't hear, sorry?
14:55
I was saying, when you didn't have the robot, was the position this one, 15 degrees, or completely right lateral?
15:03
Completely lateral, without the robot.
15:05
Ah, okay, okay, thank you.
18:54
Eleonora, please, let's start with a small colo-epiploic dissection if possible.
19:14
They're not exactly, thin, thin patients, how lovely.
20:28
Let's do the colo-epiploic dissection, give us a bit more pneumo because...
20:52
Wait, wait, wait Eleonora, open the Vessel Sealer for me please.
21:09
but the scissors have reached the end of their travel, I can't advance, that's why you see.
27:54
this is nice. The Vessel Sealer is an instrument that I appreciate very much, I use it a lot, as do my colleagues.
31:08
stay attached to the spleen because we don't need to do a neoplastic disease like
31:17
Dr. Giraldi told you. So another gauze please. I don't know until when
31:40
When we have the connection, but as long as we have it, we'll continue.
31:47
We here from Rome are following along and seeing very well.
31:57
Aspirate a bit please, there's a lesion here.
32:07
Why is the blood like this?
32:10
Come aspirate a bit.
32:13
Come aspirate a bit.
32:15
Here.
32:20
And here maybe...
32:21
Aspirate.
32:40
Okay.
32:56
No, no, but it's here, it's here, it's here.
32:57
Don't worry, don't worry.
33:03
Don't worry.
33:06
Wait.
33:14
Aspirate.
33:21
It seems it's not aspirating.
33:23
you can look, hold a little here, give me a large gauze please, but I don't have
34:52
to aspirate here, we need to be a bit quick, isn't it aspirating? Sauro?
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