Concepts and techniques in laparoscopic splenectomy

M Ishida, MD, PhD, T Morikawa, MD, PhD, T Aoki, MD, PhD, K Ariake, MD, PhD, S Maeda, MD, PhD, K Masuda, MD, PhD, K Fukase, MD, PhD, H Ohtsuka, MD, PhD, M Mizuma, MD, PhD, N Sakata, MD, PhD, K Nakagawa, MD, PhD, H Hayashi, MD, PhD, F Motoi, MD, PhD, T Naitoh, MD, PhD, M Unno, MD, PhD. Department of Surgery, Tohoku University, Graduate School of Medicine

INTRODUCTION: 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. Thanks to its low-invasiveness and cosmetic superiority, most splenectomy is now performed under laparoscopy.

Although LS seems easy and simple, there are some concepts and techniques which are common with open splenectomy and which are new to laparoscopy. Those concepts and techniques should be understood well to make LS right and accurate.

We introduce and validate 3 techniques (described in methods section) adopted  in our institute to perform LS safely and efficiently.

METHODS AND PROCEDURES: The recent five cases of LS performed in our institute in 2015 were analyzed.

For every LS, LeGEART (left gastroepiploic artery retraction technique) was adopted for lysis of adhesion between the spleen and the retroperitoneum. LeGEART is that by holding the trunk of the left gastroepiploic artery and vein up, the splenic hilum is elevated.

For ITP, the left half of the greater omentum was excised to remove latent accessory spleen, because the accessory spleen might become the cause of ITP after splenectomy.

For the cases of splenomegaly, the splenic artery was ligated at early time of operation for the purpose of shrinking the spleen for better handling and reducing blood loss by stopping the blood inflow to the spleen.

RESULTS: There were two ITP cases and three suspected cases of malignant lymphoma, and two cases of splenomegaly.

Using LeGEART, the lysis of the adhesion between the spleen and the retroperitoneum was eased up.

For all ITP cases, the left half of the greater omentum was excised. However, no accessory spleen was found in the excised greater omentum. And no adverse effect was caused by the excision of the left omentum.

The splenic artery was ligated at the early period of LS in the cases of splenomegaly. In a case, the size of the spleen turned smaller after the ligation (9cm to 6.5cm). That made it easy to handle the spleen.

CONCLUSION: The three techniques in LS were efficient ant rational. Although the surgical procedure of LS is relatively simple compared to resection of other organs, we need to consider the order of the procedures, the extent of resection of the omentum, and the technique for lysis depend on the disease and the condition of the spleen in LS.

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