Robotic Splenectomy for Refractory Immune Thrombocytopenic Purpura.

Splenectomy is a well-established surgical option for selected patients with immune thrombocytopenic purpura and persistent thrombocytopenia despite medical therapy. Although laparoscopic splenectomy remains the standard minimally invasive approach, robotic platforms may offer advantages in technically challenging cases. We present a 40-year-old woman with a 4-year history of immune thrombocytopenic purpura, obesity, Hashimoto thyroiditis, and prior sleeve gastrectomy presented with severe thrombocytopenia and abnormal uterine bleeding. After failure of medical therapy, she underwent robotic splenectomy with the da Vinci Xi robotic platform using an anterior approach. Operative time was 240 minutes, and estimated blood loss was 200 mL. The postoperative course was uneventful, and the patient was discharged on postoperative day 3. Pathologic examination findings were compatible with immune thrombocytopenic purpura. Robotic splenectomy is safe and feasible in this selected challenging case and may be considered an alternative minimally invasive approach when enhanced visualization and precise hilar dissection are desirable.