The splenic artery and vein are exposed near the hilum, using a laparoscopic ultrasonic dissector. Thrombocytopenia is not a contraindication of splenectomy. For these reasons, since its first description by delaitre. Laparoscopic splenectomy ls has progressively become. Spleen disease how is laparoscopic splenectomy performed. Handassisted laparoscopic surgery hals is another technique for laparoscopic splenectomy that offers benefits of both open and laparoscopic techniques and has proved beneficial in patients with splenomegaly craniocaudal length 22 cm or width 19 cm. Advancement in technology has extended the possibility of ls in massive splenomegaly choy et al. Laparoscopic spleen removal splenectomy clearwater. Although the anterior approach is normally used for elective laparoscopic splenectomy ls, the posterolateral approach may be superior.
Splenectomy the operation is the same on the inside. Splenectomy through laparoscopic approach is an effective technique. Pdf on jan 1, 2015, ashok gajbhiye and others published laparoscopic splenectomy find, read. Combined splenectomy with resection of left colon, sigmoid colon or rectum is usually due to injury of the spleen causing uncontrollable hemorrhage during mobilization of the splenic flexure. Since their introduction in the early 1990s, minimally invasive techniques have gained widespread acceptance because of the significant benefits that patients are able to experience. Laparoscopic splenectomy international surgery journal. Loss of requirement of any of visceral organ and endoscopic equipment make this technique more popular and easily performable. Combined laparoscopic colectomy and splenectomy for. Society of american gastrointestinal and endoscopic surgeons sages 4,927 views.
In laparoscopic splenectomy, the spleen is placed into a. Laparoscopic splenectomy is preferentially performed in the right lateral decubitus position but. Online issn 26164221 is an international, open access journal focusing on the latest research and techniques about laparoscopic. Some of these benefits include reduced postoperative pain, earlier return to normal activity, and improved cosmesis when compared with open surgery. Under general anesthesia and carbon dioxide co2 pneumoperitoneum, 86 cases of laparoscopic splenectomy ls were performed. We present a 5 minutes video of a fivetrocar laparoscopic splenectomy of a massive spleen. This is a direct consequence of referral pattens within our centers. Web of sciencetm were exported as a multifields tabdelimited files. Laparoscopic splenectomy ls is applied to various diseases such as splenic tumor, liver cirrhosis, and idiopathic thrombocytopenic purpura itp for treatment and to homological diseases for diagnosis. Pain experienced by the open technique is greater and longer lasting.
We recently reported a combined laparoscopic splenectomy and colectomy for unrelated pathologies including sigmoid diverticulitis and granulomatous splenic lesions due to sarcoidosis. As a result, singleport laparoscopic splenectomy spls has been preferred by some surgeons 1517. When the size of the spleen is extremely large, it is difficult to perform the laparoscopic. To meet this need, we designed and developed a suctioncup grasper that allows easy grasping and manipulation of the spleen. Splenectomy, laparoscopic splenectomy, open splenectomy, laparoscopic versus open splenectomy. The blood supply to the spleen is tied and divided. Lateral dissection of the vessels provides less operative complications in children. In the 1995, kusminsky et al 4 introduced the handassisted laparoscopic technique as an adjunct to laparoscopic splenectomy. Possible complications may include cannula site infections, pneumonia, internal bleeding or infection inside the abdomen at the site where the spleen used to be, although these.
Laparoscopic splenectomy is indicated for various benign hematologic diseases, malignant hematologic diseases, secondary hypersplenism, and other anatomic disorders of the spleen. Laparoscopic splenectomy for a ruptured spleen has been reported only in a few cases, in which a handassisted technique was used. Your spleen is a beanshaped organ found under your ribs on the left upper side of your abdomen stomach. The patient is placed on the operating room table in the right lazy decubitus position using a bean bag with the right arm abducted and the left arm adducted anterior and superior.
The thin fibrous attachments between the spleen and the diaphragm are divided. Introduction n owadays, laparoscopy is the standard approach to performsplenectomyinchildren. Abstractbackground and objectives the aim of this study was to. The advantages of laparoscopic splenectomy include a shortened postoperative hospitalization, improved cosmesis, and less analgesic requirements. The spleen acts as a filter to help fight infections and maintain the amount of blood in your body by destroying old blood cells. It removes old and damaged blood cells as blood passes through it. The blood flowing to the the spleen is as a result diverted to the liver, this enhances its healing. The patient is placed in the right lateral decubitus position. Laparoscopic splenectomy in a case of blunt abdominal trauma. Laparoscopic splenectomy inpatient care what you need. Open splenectomy atata metaaanaanali ith h i li tilysis with an emphasis on complications 51 series p p y2940 pts of splenectomy from 1991 from 199120022002 laparoscopic splenectomy 2119 pts longer to perform hi h i k f bl dihigher risk of bleeding superior to open decreased length of stay.
Your spleen is located to the left of your stomach. Thanks to its lowinvasiveness and cosmetic superiority, most splenectomy is now performed under laparoscopy. Clinical response itp after laparoscopic splenectomy. Indications for laparoscopic splenectomy are the same as those for open splenectomy except when emergency splenectomy and exploratory laparotomy for traumatic injuries are needed. The singleport laparoscopic surgery has been expected to satisfy patient demand of cosmesis or to decrease pain by reducing trocar incisions. Laparoscopic splenectomy using conventional instruments. Lateral approach for laparoscopic splenectomy fernandezananin. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Laparoscopic splenectomy using the suspended pedicle technique. With the evolution of laparoscopic surgery comes the need for specific instruments that apply traction to parenchymal tissue, like the spleen, without exposing the organ to the associated high risk of bleeding. Throughout the nearly last three decades, different approaches have been described since delaitre and maignien reported the first minimally invasive splenectomy in 1991.
Preoperative splenic artery embolization, begun with the third patient, helped to reduce operative blood loss and made the procedure easier to perform. Finally, a laparoscopic splenectomy requires the surgeon to have advanced laparoscopic skills and therefore it may be underutilized. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. With the advent of laparoscopic techniques, laparoscopic splenectomy has become the procedure of choice for benign and malignant. Qualified surgeons and the necessary equipment are at. The film presents laparoscopic splenectomy in child with congenital spherocytosis. The chart showing pdf series, word series, html series, scan qr. Laparoscopic splenectomy in child vessels first technique. Laparoscopic splenectomy is a minimally invasive surgical procedure that is used to remove a diseased or enlarged spleen. Although ls seems easy and simple, there are some concepts and. The laparoscopic technique for splenectomy has become the preferred method for splenectomy at many institutions over the last 10 years. Splenectomies may be performed via open or laparoscopic technique. Patient engagement patient education 116,890 views.
Pereira is a big factor in a successful outcome, the size of the spleen is the most important determinant in deciding whether the spleen can be removed laparoscopically. Procedure was performed in the department of pediatric surgery in zabrze, medical university of silesia, poland. Laparoscopic vs open splenectomy minimally invasive surgery. 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 possibly a few centimeters to allow for removal of spleen tissue. Data sources include ibm watson micromedex updated 4 may 2020, cerner multum updated 4 may 2020, wolters kluwer updated. This positioning allows gravity to assist in the dissection of the splenic attachments and it. Pdf since their introduction in the early 1990s, minimally invasive. Laparoscopic splenectomy for massive splenomegaly is still a controversial and challenging procedure. Complications following laparoscopic splenectomy are infrequent, but you should consult your doctor regarding possible complications based on your specific case.
Bipolar cautery, ligasure, harmonic scalpel, or similar instrument is needed for the laparoscopic procedure and may be used for the open procedure as well. Concepts and techniques in laparoscopic splenectomy. Handassisted laparoscopic surgery hals uses a port large enough to accommodate the. As a part of ongoing research process, we are doing laparoscopic splenectomy in patients with early liver diseases. Laparoscopic splenectomy benefits of laparoscopic splenectomy similar to those of other laparoscopic procedures decreased pain quicker return of bowel function shorter hospital stay improved cosmetic result low conversion rate morbidity similar to open accessory spleens may be easier to miss minkes rk, lagzdins m, langer jc. Specific recommendations may vary among health care professionals. Splenectomy is indicated when medical treatment failed clinical response itp after laparoscopic splenectomy 84. The approach is determined by the disease process and clinical stability of the patient. We have retrospectively compared the effectiveness and safety of these approaches in patients with. Splenectomy is also indicated in patients who recur after cessation of therapy.
Perioperative management, surgical technique, and results. Laparoscopic splenectomy ls provides health benefits to patients compared with open splenectomy os in terms of perioperative morbidity, complications, and patient recuperation. Traditionally, removal of the spleen accomplished by one large commonly a left subcostal or a left upper paramedian incision. If you have a question about your need for a laparoscopic splenectomy, your alternatives, billing or insurance coverage, or your surgeons training and experience, do not hesitate to ask your surgeon or hisher office staff about it. Laparoscopic splenectomy is surgery to take out all or a part of your spleen. A prospective, randomized, controlled trial comparing these techniques is planned. Current concepts of laparoscopic splenectomy in elective patients. Splenectomy is often required in children for various hematologic disorders, although massive splenomegaly is uncommon in pediatric age. Laparoscopic splenectomy was first documented by delaitre and maignien in 1991. It also makes immune system cells, called lymphocytes, which help fight germs and infections. 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. Since the earliest reports of laparoscopic splenectomy ls in 1991 and. This has been extremely successful and has given an excellent result in our small series. Case report singleport laparoscopic partial splenectomy for a huge splenic cyst.
Absolute and relative contraindications for laparoscopic splenectomy are listed in table 1. Laparoscopic splenectomy ls is an accepted procedure for elective splenectomy. Laparoscopic splenectomy was completed successfully in 143 97. An evaluation of the techniques and clinical results of multiport laparoscopic splenectomy. Journal of the society of laparoendoscopic surgeons, volume 18. Laparoscopic splenectomy aftercare instructions what. Laparoscopic splenectomy, in the authors experience, is a safe alternative to open splenectomy, has few complications, is cost effective, and has been well accepted by patients and families. Laparoscopic splenectomy for massive splenomegaly in a. A technique for laparoscopic splenectomy is described. The patient is placed in the right semidecubitus position and pneumoperitoneum is prepared. Increased peripheral platelets destruction spleen, liver. Laparoscopic vs open splenectomy minimally invasive. Laparoscopic splenectomy should be considered the standard of care for patients. Laparoscopic splenectomy coupled with laparoscopic.
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