Minimally invasive laparoscopic and robotic technologies in the treatment of patients with echinococcal cysts of the spleen

Background. Echinococcal cysts are localized in the spleen much less frequently than in the liver or lungs. The most accessible and generally accepted method of treatment in this case is splenectomy. However, the postoperative period in such patients is often complicated by the development of infectious complications with high mortality. Material and methods. A retrospective analysis of the treatment of 11 patients with isolated echinococcal cysts of the spleen was performed at the surgical clinic of Botkin Hospital in the period from 2018 to 2022. An original technique of partial resection of the spleen was developed and introduced into practice, according to which short gastric vessels were preserved, the branches of the splenic artery and vein were clamped with vascular clamps, followed by transecting the parenchyma along the demarcation line. Intraoperative ultrasound was used to monitor the blood supply to the splenic remnant. In 9 cases, the operation was performed laparoscopically, in 2 cases — robot-assisted. The overall incidence of complications according to Clavien—Dindo, the incidence of pancreatic fistula, and the duration of postoperative hospital stay were assessed. Results. No patient underwent conversion of access. In the postoperative period, 2 patients had complications of Clavien—Dindo class I and II. No complications of classes III—IV were detected, there were no fatal outcomes. The average duration of postoperative hospital stay of patients was 4.9±3.9 days. Conclusion. Partial resection is an effective and safe alternative to splenectomy. With sufficient experience of the operating team and modern equipment, surgery from a minimally invasive approach is preferable.