Takeshi Aoki, Takeshi Naitoh, Takanori Morikawa, Katsuyoshi Kudoh, Shinobu Ohnuma, Naoki Tanaka, Tomoya Abe, Hiroaki Musha, Michiaki Unno. Department of Surgery, Tohoku University Graduate School of Medicine.
We have innovated a novel surgical procedure for Laparoscopic splenectomy (LS), which is called as Left gastrio-epiploic artery traction (LeGEART) method, mainly for idiopathic thrombocytopenic purpura (ITP).
Since the first report of LS in 19911, LS is considered as the one of the standard technique for patients requiring an elective splenectomy. In our institution, LS was first undertaken in 1996. Since then, LS have been performed mostly for patients with hematological disorder, especially idiopathic thrombocytopenic purpura (ITP). In LS, pancreatic fistula is most serious postoperative complication. Therefore, we have innovated safety technique for LS.
[Material and Surgical technique]
This method has two concepts. One is not to damage the pancreas, and another not to remain the accessory spleens.
In this method, the pedicle containing left gastro-epiploic vessels has been towed in the direction of ventral side by assistant’s forceps. The distance between the pancreatic tail and splenic hilum is prolonged and the triangle shape, formed by pancreatic tail, spleen, and Gerota’ fascia, makes it easy to insert the linear stapler toward the upper site of the splenic hilum, under good traction without damaging the pancreatic tissue.
On the other hand, accessory spleens are congenital foci of healthy splenic tissue that are separate from the main body of the spleen. In our current cases, most frequent places of accessory spleens were splenic hilum and inferior pole of spleen, and 30% of cases accessory spleens were placed in the left side of greater omentum. It is very important not to remain the accessory spleen for ITP’s operation. So we have dissected greater omentum together using LeGEART method.
We believe that LeGEART method will simplify the LS, especially for ITP.