Journal of Robotic Surgery

, Volume 13, Issue 6, pp 791–792 | Cite as

The role of hand-assisted laparoscopic splenectomy for mega spleens in the da Vinci era

  • Gregorio Di FrancoEmail author
  • Desirée Gianardi
  • Matteo Bianchini
  • Matteo Palmeri
  • Luca Morelli
Letter to the Editor

Dear Editor,

We read with great interest the article by Cavaliere et al., entitled “Robotic vs laparoscopic splenectomy for splenomegaly: A retrospective comparative cohort study” published on International Journal of Surgery [1].

Laparoscopic splenectomy is nowadays considered the gold standard for normal to moderately enlarged spleens. However, in case of more challenging conditions such as mega spleens or cirrhotic patients, the laparoscopic approach is still associated with high risk of intra-and post-operative bleeding, high conversion rate, and high morbidity.

In this setting, the authors compared the robot-assisted laparoscopic surgery (RAS) with the direct manual laparoscopy (DML), reporting possible advantages with the use of the da Vinci system for splenectomy in case of splenomegaly. In particular, they reported improved outcomes with RAS in terms of reduced intraoperative bleeding and less conversions to open surgery, although if they also admitted the limitations of the...


Compliance with ethical standards

Conflict of interest

Gregorio Di Franco, Desirée Gianardi, Matteo Bianchini, Matteo Palmeri and Luca Morelli declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of article, informed consent is not required.


  1. 1.
    Cavaliere D, Solaini L, Di Pietrantonio D et al (2018) Robotic vs laparoscopic splenectomy for splenomegaly: a retrospective comparative cohort study. Int J Surg 55:1–4. CrossRefPubMedGoogle Scholar
  2. 2.
    Morelli L, Di Franco G, Guadagni S et al (2018) Robot-assisted total mesorectal excision for rectal cancer: case-matched comparison of short-term surgical and functional outcomes between the da Vinci Xi and Si. Surg Endosc 32:589–600. CrossRefPubMedGoogle Scholar
  3. 3.
    Morelli L, Ceccarelli C, Di Franco G et al (2016) Sexual and urinary functions after robot-assisted versus pure laparoscopic total mesorectal excision for rectal cancer. Int J Colorectal Dis 31:913–915. CrossRefPubMedGoogle Scholar
  4. 4.
    Morelli L, Tartaglia D, Bronzoni J et al (2016) Robotic assisted versus pure laparoscopic surgery of the adrenal glands: a case–control study comparing surgical techniques. Langenbeck’s Arch Surg 401:999–1006. CrossRefGoogle Scholar
  5. 5.
    Morelli L, Di Franco G, Guadagni S et al (2017) Full robotic colorectal resections for cancer combined with other major surgical procedures: early experience with the da Vinci Xi. Surg Innov 24:321–327. CrossRefPubMedGoogle Scholar
  6. 6.
    Furbetta N, Palmeri M, Guadagni S et al (2019) Gastrointestinal stromal tumours of stomach: robot-assisted excision with the da Vinci surgical system regardless of size and location site. J Minim Access Surg 15:142. CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Morelli L, Di Franco G, Guadagni S et al (2018) Robotic-assisted versus open left pancreatectomy for cystic tumours: a single-centre experience. J Minim Access Surg. CrossRefPubMedGoogle Scholar
  8. 8.
    Guadagni S, Furbetta N, Di Franco G et al (2019) Robotic-assisted surgery for colorectal liver metastasis: a single-centre experience. J Minim Access Surg . CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Morelli L, Di Franco G, Lorenzoni V et al (2019) Structured cost analysis of robotic TME resection for rectal cancer: a comparison between the da Vinci Si and Xi in a single surgeon’s experience. Surg Endosc 33:1858–1869. CrossRefPubMedGoogle Scholar
  10. 10.
    Pietrabissa A, Morelli L, Peri A et al (2011) Laparoscopic treatment of splenomegaly: a case for hand-assisted laparoscopic surgery. Arch Surg 146:818–823. CrossRefPubMedGoogle Scholar
  11. 11.
    Huang Y, Wang X-Y, Wang K (2019) Hand-assisted laparoscopic splenectomy is a useful surgical treatment method for patients with excessive splenomegaly: a meta-analysis. World J Clin Cases 7:320–334. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Sun X, Liu Z, Selim M, Huang Y (2019) Hand-assisted laparoscopic splenectomy advantages over complete laparoscopic splenectomy for splenomegaly. Surg Laparosc Endosc Percutaneous Tech 29:109–112. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.General Surgery Unit, Department of Surgery, Translational and New Technologies in MedicineUniversity of PisaPisaItaly
  2. 2.EndoCAS (Center for Computer Assisted Surgery)University of PisaPisaItaly

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