Laparoscopic operations on the spleen

Abstract

Background: Advances in instrumentation and surgical technique have made it possible to perform minimally invasive surgery on parenchymal organs including the spleen. In splenic surgery, organ preservation has high priority due to the organ's important immunological functions. This must also be taken into consideration when doing laparoscopic procedures. material and Methods: Laparoscopic splenectomy and hemisplenectomy are performed using 3-4 trocars, with the patient in a right semilateral position. Blood vessels are dissected and the spleen mobilized using the ultrasound scalpel or LigaSure instrument. The vessels are carefully exposed and, in the case of hemisplenectomy, selectively dissected. For splenectomy, an endostapler with a vascular cartridge is usually used to server the hilar vessels. For partial resections, the parenchyma is also severed with an endostapler. In a 5-year period, 109 patients underwent this procedure. 15 of them had a resection of the lower pole and 29 of the upper pole. four patients had a subtotal resection and 61 were splenectomized. Results: Laparoscopic splenectomy or hemisplenectomy was successfully completed in 105 of 109 patients. Four patients had to be converted due to intraoperative bleeding. Hospital mortality was 0. In all cases in which a partial splenectomy was performed for diagnostic purposes a firm diagnosis could be established. Conclusion: Laparoscopic operations have proved to be feasible and advisable for spleens with a long axis up to 24 cm. laparoscopic technique can be seen as standard for normal-sized or slightly enlarged spleens. Patients with hematological diseases in whom the surgical risk is higher due to their comorbidity have the greatest benefit from these operations.