Laparoscopic Partial Splenectomy Assisted by Fluorescence in a 13-Year-Old Girl

Abstract

Partial splenectomy allows preserving immune function in benign splenic lesions such as epidermoid cysts. Determining the plane of resection and perfusion of the spleen remnant can be difficult, especially in centrally located lesions. We present a 13-year-old girl with a symptomatic splenic cyst of 6 cm in diameter located next to the splenic hilum. Laparoscopic partial splenectomy was performed through a 10-mm umbilical approach and three accessory 5-mm ports. Intraoperative intravenous injection of indocyanine green (ICG) at 0.2 mg/kg guided the careful dissection of the splenic hilum and checked the spleen perfusion once the upper arterial branch was clamped. The subsequent wash-out of the ICG allowed inspection of the peripheral vascular return of the splenic remnant through polar veins. Surgery was uneventful with minimal blood loss. Follow-up ultrasound scan revealed a well-perfused small splenic remnant with no signs of recurrence.Laparoscopic partial splenectomy is feasible in benign splenic tumors, especially in those cases of peripheral location. Fluorescence facilitates the safe dissection of the splenic hilum, the visualization of the transection plane of the spleen and the perfusion of the remnant in cases of anatomically and technically complicated partial splenectomies.

Evaluating the Development Status of Fluorescence-Guided Surgery (FGS) in Pediatric Surgery Using the Idea, Development, Exploration, Assessment, and Long-Term Study (IDEAL) Framework

“…Additionally, several papers explored the application of fluorescence in non-neoplastic lesions: one case of lung lesion resection entailed granulomatous inflammation with focal necrosis [ 47 ], one case of laparoscopic resection of a pancreatic nodule entailed a case of focal congenital hyperinsulinism [ 48 ], and one case of laparoscopic partial splenectomy entailed a splenic cyst [ 49 ]. Additionally, there was one case of thoracoscopic cystic adenomatoid malformation resection and one case of thoracoscopic pulmonary extra-lobar sequestration resection [ 10 ].…”

Indocyanine green dye and its application in gastrointestinal surgery: The future is bright green

“…It is unlikely that routine use of ICG would be indicated in straightforward cases. However, it could be useful in the identification and division of the splenic artery and vein in cases where there is anatomic distortion or adhesions from prior inflammation[ 79 ]. This is important as bleeding from these vessels can be substantial, and it is more difficult to obtain control in laparoscopic or robotic surgery compared to open surgery.…”

“…Bertolucci et al [ 81 ] reported a case where ICG was used in a laparoscopic splenic artery aneurysmectomy to confirm successful clip and resection of aneurysm. The use of ICG FI also enabled assessment of splenic blood supply, allowing for laparoscopic partial splenectomy in 4 patients[ 79 ].…”

Laparoscopic dome resection for pediatric nonparasitic huge splenic cyst safely performed using indocyanine green fluorescence and percutaneous needle grasper

“…Ours is the first report to describe the use of ICG fluorescence in surgery for splenic cysts. Bada‐Bosch et al 10 reported the performance of pediatric partial splenectomy for splenic cysts using ICG fluorescence for guidance. They used ICG and confirmed the transection line of the spleen after ligature of splenic vessels.…”