Patient selection, practice patterns, and perioperative outcomes for robotic splenectomy: a contemporary ACS-NSQIP analysis

BACKGROUND: Robot-assisted surgery has increasingly been adopted across multiple surgical specialties, demonstrating benefits such as enhanced precision and visualization, and potentially improved outcomes. However, evidence for its use in less common operations, including splenectomy, remains limited. To better understand its use and outcomes, we examined practice patterns and perioperative results of robotic splenectomy in a large, contemporary national cohort. METHODS: The American College of Surgeons - National Surgical Quality Improvement Program database was queried for adult patients who underwent open, laparoscopic, or robotic splenectomy from 2022 to 2023; patient characteristics were categorized by type of surgical approach. Perioperative outcomes for robotic vs. laparoscopic splenectomy were analyzed using univariable and multivariable analyses. RESULTS: Among 852 eligible patients that underwent splenectomy, 163 (19%) operations were performed using the robotic approach, while 339 (39.7%) were laparoscopic and 350 (41.1%) were open. The most common indications for robotic splenectomy were benign hematologic conditions (33%), neoplasm/mass/cyst (32%), and splenomegaly (18%). Compared to laparoscopic surgery, robotic splenectomy was associated with longer operative time (152 vs. 130 min, p < 0.001) but shorter length of stay (3.6 vs. 5.2 days, p = 0.010). Notably, there were no significant differences in the proportion of patients experiencing an unplanned conversion to open surgery, postoperative blood transfusions, or other postoperative complications between the robotic and laparoscopic cohorts. CONCLUSION: In this large contemporary national cohort, robotic splenectomy was safe, with low morbidity, shorter hospitalization, and longer operative times compared to laparoscopic surgery. These findings support the feasibility and safety of robotic splenectomy with appropriate patient selection.