A New Technique for Laparoscopic Splenectomy and Azygoportal Disconnection

Abstract

Background. Laparoscopic splenectomy and azygoportal disconnection (LSD) using many different surgical techniques has become increasingly popular for treatment of cirrhotic patients with bleeding portal hypertension and secondary hypersplenism. Surgical procedures with the least possible impairment are consistently expected by both surgeons and patients. Here, we report a clinical cohort of 10 patients who underwent LSD with a new technique and present the advantages of less impairment during performance of this new technique. Methods. A cohort of 10 cirrhotic patients with bleeding portal hypertension and secondary hypersplenism treated with LSD were studied. During the procedure, an electromechanical morcellator allowed for easy extraction of the entire massive splenic tissue without a cumbersome intracorporeal bag, enlarged incision, or hand-assisted incision. Various perioperative data were recorded. Results. LSD was successful in all patients. There was no conversion to open operations or significant perioperative complications. The operative time was 288.0 ± 53.9 minutes, the spleen removal time was 39.3 ± 15.1 minutes, and blood loss was 240.0 ± 217.1 mL. Conclusions. This new technique involving the use of an electromechanical morcellator provides expedient recovery and minimal postoperative pain and scarring. LSD with this technique is a feasible, effective, and safe surgical procedure, and embodies all the benefits of minimally invasive surgery for cirrhotic patients with bleeding portal hypertension and hypersplenism.

Laparoscopic Splenectomy and Azygoportal Disconnection: a Systematic Review

“…To the best of our knowledge, ours was the first report of the use of an electromechanical morcellator to draw a massive amount of splenic tissue completely from the abdominal cavity during LSD. 23 Our study suggested that, compared with OSD, MLSD is associated, not only with the above-mentioned advantages, but also with many other advantages, including better liver and renal function, 26 lower inflammatory immune responses with fewer postoperative days of elevated temperature (>38.0°C), lower white blood cell counts, 24 and lower concentrations of C-reactive protein, interleukin-6,-and procalcitonin. 26 …”

“… 40 A variety of surgical techniques are currently used to extract the spleen during LSD, including cumbersome intracorporeal bags to withdraw massively enlarged spleens, creation of enlarged incisions to morcellate and withdraw splenic tissue, and hand-assisted laparoscopy. 11 , 16 – 20 , 40 – 43 The year 2012 saw the introduction of an MLSD technique that greatly reduces impairments, 23 , 24 , 26 , 27 in which a massively enlarged spleen is removed from the abdominal cavity through the existing incision using an electromechanical morcellator. MLSD is an even less invasive laparoscopic technique that will extend the advantages of laparoscopic surgery to patients likely to benefit the most: those with cirrhosis with bleeding portal hypertension and hypersplenism.…”

“…In 2012, we developed MLSD, a new technique that greatly reduces impairments. 23 , 24 , 26 , 27 To date, we have performed MLSD in more than 100 patients with liver cirrhosis, portal hypertensive bleeding, and secondary hypersplenism. To the best of our knowledge, ours was the first report of the use of an electromechanical morcellator to draw a massive amount of splenic tissue completely from the abdominal cavity during LSD.…”

“…In January 2013, Cheng et al 22 reported 80 cases in their controlled study. In June 2013, Jiang et al 23 reported 10 cases. In September 2013, Bai et al 24 reported 37 cases in their controlled study.…”

A Novel Technique for Synchronous Laparoscopic Splenectomy and Azygoportal Disconnection With Hepatectomy

“…The entire spleen was removed with an electromechanical morcellator (Figure 4) as described in our previous reports. 9,10 The spleen specimen was cylindrical in shape (Figure 5). The liver specimen was loaded into the homemade specimen bag and removed though the umbilical port, which was extended properly along the above linea alba.…”