After getting enough exposure from the hilum of spleen, securing vascular pedicle an. Since the first report of laparoscopic splenectomy by delaitre and maignien in 1991, laparoscopic splenectomy has become a standard procedure for elective removal. The spleen is delivered to the midline by means of blunt and sharp dissection of the areolar plane between the kidney and the pancreas. Absolute and relative contraindications for laparoscopic splenectomy are listed in table 1. Indications for laparoscopic splenectomy are similar to those of open splenectomy except when emergency splenectomy. Laparoscopic spleen removal splenectomy patient information. Pdf on jan 1, 2015, ashok gajbhiye and others published laparoscopic. Laparoscopic splenectomy is a potential surgical option for the treatment of isolated gynecologic cancer recurrence to the spleen 1 x 1 ramirez, p.
Handassisted laparoscopic surgery hals is another technique for laparoscopic splenectomy that offers benefits of both open and laparoscopic techniques and has proved. Download files by right click and save target as please. We present a handassisted technique that allows the performance of a laparoscopic splenectomy safely and rapidly by surgeons without a great deal of experience with this procedure. The spleen is one of the most frequently injured intraperitoneal organs, and management of splenic injuries may require splenectomy or, rarely, splenorrhaphy. Splenectomy in childhood usually is required for hematologic disorders such as hereditary spherocytosis, immune thrombocytopenic purpura, or sickle ce. Open splenectomy is still the most common technique. Since the earliest reports of laparoscopic splenectomy ls in 1991 and 1992, 14 it has grown to become one of the most widely performed laparoscopic solidorgan procedures. The approach is determined by the disease process and clinical stability of the patient. Pain experienced by the open technique is greater and longer lasting. Laparoscopic splenectomy for a ruptured spleen has been reported only in a single case, in which a handassisted technique was used. Laparoscopic splenectomy ls, first described in 1991, is often the preferred approach in an elective setting. Jun 25, 2011 laparoscopic splenectomy using the suspended pedicle technique. The evolution of the technique has come with better understanding of the surgical anatomy of the spleen, making the lateral approach preferable in most instances. Splenectomy for therapeutic or diagnostic purposes may be necessary in malignancies involving the spleen, such as myelofibrosis, hodgkin lymphomas, and hairy cell leukemias.
Yet reports on singleincision laparoscopic surgery sils for massive splenomegaly is not seen, neither is sils for gastroesophageal devascularization. Among them, the most used ones are polymer clips, enbloc stapling and ultrasonic devices. In some cases a surgeon may begin with a laparoscopic approach and find it necessary to make a larger incision because of scar tissue from previous operations or other complications. In the 1995, kusminsky et al 4 introduced the handassisted laparoscopic technique as an adjunct to laparoscopic splenectomy. Jun 04, 2016 splenectomy is also indicated in patients who recur after cessation of therapy. Splenectomy is also indicated in patients who recur after cessation of therapy. Laparoscopic splenectomy and azygoportal disconnec. The cosmetic results of four small incisions made with the laparoscopic approach are more pleasing than the one large incision used for the open technique. Free operative study material pdf slides opearive technique. The blood supply to the spleen is tied and divided. Laparoscopic spleen removal splenectomy can result in shorter hospital stays and faster return to normal. Laparoscopic splenectomy ls is the second level of skill for a surgeon. Technical standardization of laparoscopic splenectomy.
The speed of this technique varies depending on the manner of ligation used. However, the laparoscopic technique is much more challenging when performed in patients with cirrhosis, portal hypertension, and splenomegaly. Splenomegaly presents significant surgical challenges that can limit application of this laparoscopic technique. This video demonstrates a splenectomy for idiopathic thrombocytopenic purpura itp in a young patient. As compared with open splenectomy, laparoscopic splenectomy. Therapeutic laparoscopy, especially splenectomy in a trauma setting, is controversial. Singleport techniques will not be described further here. Finally, a laparoscopic splenectomy requires the surgeon to have advanced laparoscopic skills and therefore it may be underutilized. In this key lecture, professor antonio durso outlines the basic principles of laparoscopic splenectomy using a range of specific instruments suited for different technical cases.
When the size of the spleen is extremely large, it is difficult to perform the laparoscopic technique. Depending on the surgical team and the chosen laparoscopic technique, usually four or five ports suffice for a splenectomy, with one for the laparoscopic camera tube, and only one of any size. Indications of laparoscopic splenectomy are the same as in the open technique. Splenectomy open and laparoscopic techniques abdominal key. Step by step explanation and demonstration of surgical, gynaecological and urological laparoscopic operative procedures. Various techniques are used in the management of splenic hilum during laparoscopic splenectomy. Bipolar cautery, ligasure, harmonic scalpel, or similar instrument is needed for the laparoscopic procedure and may be used for the open procedure as well. Oct 29, 2018 background open splenectomy is performed in two major clinical scenarios. The aim of this paper is to present the technique and the tricks for a succesfull splenectomy. Absolute and relative contraindications for laparoscopic splenectomy. Handassisted laparoscopic surgery hals uses a port large enough to accommodate the surgeons hand. Laparoscopic splenectomy has become our procedure of choice for elective removal of normalsized laparoscopic splenectomy. Laparoscopic splenectomy using the suspended pedicle technique.
Laparoscopic splenectomy accesssurgery mcgrawhill medical. Singleincision laparoscopic splenectomy has been reported and was proved to be feasible and safe. The least complicated anatomic approach to splenectomy that ensures no inadvertent ligation of the pancreatic or left gastroepiploic vessels is the hilar ligation technique. Laparoscopic management of splenomegaly entails a more demanding technique, and manipulation of a large organ and extraction of the viscera may be more difficult. Download files by right click and save target as please keep patience.
It is not yet commonly performed because elective splenectomy. The main principles for accessory and large spleen management are demonstrated including a brief description of stepwise dissection maneuvers along with complications. Method fiftyone patients who had laparoscopic splenectomy. Perioperative management, surgical technique, and results article pdf available in journal of gastrointestinal surgery 182 october 20 with 545 reads. To the best of our knowledge, there is no study in the literature comparing the results of clip and stapler techniques. Advancement in technology has extended the possibility of ls. We present the first reported case, to our knowledge, of successful removal of a ruptured spleen by means of a totally laparoscopic technique. Splenectomy in patients with advanced or recurrent ovarian cancer. Laparoscopic splenectomy ls is an accepted procedure for elective splenectomy.
Laparoscopic splenectomy should therefore be considered the technique of choice and should prompt earlier consideration of surgery for patients with selected hematologic disorders. The speed of this technique varies depending on the man ner of ligation used, with the use of a ves. Laparoscopic splenectomy in veterinary medicine has been documented in both cats and dogs using both a multiple. Laparoscopic splenectomy using conventional instruments. Technique splenectomy of laparoscopic various approaches was described for laparoscopic splenectomy by the. Complications of laparoscopic splenectomy minimally. Gurgaon, delhi ncr, india, discusses the steps of laparoscopic splenectomy for chronic. For the lateral approach, the operation begins with safe laparoscopic abdominal access.
Splenectomy the operation is the same on the inside. Apr 15, 2016 objective to describe the operative technique and perioperative outcome for laparoscopic assisted splenectomy las in dogs. With the spleen retracted medially, the phrenicocolic ligament is incised. Laparoscopic splenectomy aftercare instructions what. Lateral approach has been proposed as an alternative to the anterior approach which facilitates ls. Laparoscopic splenectomy requires careful identification and ligation of the various ligaments that surround the spleen. To universally perform laparoscopic splenectomy safely on patients with liver cirrhosis and portal hypertension, we standardized the techniques and clari. Laparoscopic splenectomy in children with sickle cell disease. The laparoscope provides magnification and high intensity light so that the surgeon can see small details and into nooks and crannies easier. The aim of this paper is to compare the results of. Laparoscopic splenectomy is the preferred approach for the removal of normalsized spleens.
Research and clinical studies have documented the feasibility of this technique. Also, laparoscopic and robotic techniques are applied in various centers 123 4. This can be accomplished with an open or a closed technique, in accordance with the skill, experience, and comfort level of the surgeon. The first line of treatment is medical therapy but when this is not successful, removal of the spleen splenectomy can be curative or at least significantly improve the platelet count in the vast majority of cases. Background open splenectomy is performed in two major clinical scenarios. Handassisted laparoscopic splenectomy vs conventional. With the development of various systems handport, surgeons can insert their hand into the abdomen while maintaining pneumoperitoneum. Splenectomies may be performed via open or laparoscopic technique. Singleincision laparoscopic splenectomy for massive. Robotassisted splenectomy follows the same surgical principles than a more conventional laparoscopic technique. Laparoscopic splenectomy with a left inguinal incision is a safe and effective approach in children with scd. Your spleen is a beanshaped organ found under your ribs on the left upper side of your abdomen.
Laparoscopic splenectomy small animal laparoscopy and. The success of laparoscopic cholecystectomy has favored the application of this technique in abdominal surgery. A ruptured spleen usually requires open splenectomy. As compared with open splenectomy, laparoscopic splenectomy results in decreased length of stay, decreased narcotic use, improved cosmesis and an overall low complication rate. Yet reports on singleincision laparoscopic surgery sils for massive splenomegaly is. The thin fibrous attachments between the spleen and the diaphragm are divided. Laparoscopic splenectomy ls suffers from several technical problems for mobilization and manipulation of a solid organ. With this technique, the vessels are ligated as they terminate into the spleen. There are also presented some datas of history of spleen surgery and surgical anatomy. Spleen removal surgery laparoscopic splenectomy preop patient education duration. Research and clinical studies have documented the feasibility of this technique, and early work suggests that animals undergoing this procedure have decreased blood loss, pain scores, and wound. Objective to describe the operative technique and perioperative outcome for laparoscopic assisted splenectomy las in dogs design retrospective case series. Laparoscopic splenectomy should therefore be considered the technique. Ls in comparison with open surgery offers the same efficacy in the control of hematologic disease with the additional benefits of a minimally invasive approach.
Pdf laparoscopic splenectomy sunil lanjewar, kuntal. Laparoscopic splenectomy international surgery journal. Spleen was delivered enblock from a fanestiel incision. Jul 17, 2018 laparoscopic splenectomy isnt appropriate for everyone. Pdf a new technique for laparoscopic splenectomy with. Since the application of handassisted techniques, the application of laparoscopic splenectomy has expanded. With the advent of laparoscopic techniques, laparoscopic splenectomy has become the procedure of choice for benign and malignant. Splenectomy some surgeons feel that their ability to see fine detail is improved with a laparoscopic procedure. All patients received the general anesthesia and were placed in three different operative positions. Pulmonary, hemorrhagic, infectious, pancreatic, and. Singleincision laparoscopic splenectomy for massive splenom. Laparoscopic splenectomy for secondary cytoreduction of. Since platelets are blood cells which aid in blood clotting, patients are at risk for bleeding.