Robotic Removal of a Hypogastric Splenic Cyst. A Case Report and Review of Literature

Background: Splenic cysts are infrequent findings in everyday medical practice. They are usually associated with nonspecific symptoms and the diagnosis is incidental. In most instances they are located in the left subcostal region, except for cases of huge sized cysts which can extend to the whole abdomen or pelvis. Aim: To present a case of a large hypogastric splenic cyst in a nulliparous woman, managed with robotic cystectomy. Review of the literature is included. Case: A 19-year-old woman, presented to the gynecologic department with a painless, palpable mass in the lower abdomen. Ultrasonography revealed a pelvic cystic mass, originally misdiagnosed for an ovarian cyst. Serum biomarkers and β-hCG were negative. Definite diagnosis was made during explorative laparoscopy where the cyst was found to originate from the spleen. The surgery setup was changed from a lower to upper abdominal procedure. A robotically-assisted cystectomy was performed without concurrent splenectomy, and the splenic cavity was filled with an omental patch. There was no blood loss and the operation time was 163 minutes. Recovery was uneventful and there was no recurrence for a period of 16 months postoperatively. Conclusions: Pelvic splenic cysts are rare, and may be incidental findings during routine abdominal ultrasound scans. Modern minimally invasive approaches such as robotic surgery offer safe and efficient alternatives to standard techniques.