Laparoscopic Splenectomy for Patients with Immune Thrombocytopenia and Very Low Platelet Count: Is Platelet Transfusion Necessary?

Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review

“…A low platelet count (<10×10 9 /l) should no longer be considered as an absolute contraindication. Current literature states that the constant increased experience for the operation, as well as advances in laparoscopic techniques and instruments, have made it possible to operate on patients with low platelet counts safely and effectively (9).…”

“…Most authors prefer the lateral approach for spleen mobilization (7,9,10,14,20). Almost all of them agree that the division of the gastrosplenic ligament and the short gastric vessels can be safely performed using an ultrasonic scalpel, while Al-Mulhim advocates the use of Ligaclips for the ligation of short gastric vessels greater than 4 mm in diameter (7).…”

“…Similarly, almost authors agree that the splenic vascular hilum can be safely divided by using a laparoscopic linear cutting stapler with vascular staples, assuming that the pancreatic tail has been isolated, in order to reduce the risk of pancreatic injury (6,9,10,13,(19)(20)(21)(22). However, several modifications have been proposed.…”

“…Tran et al preferred to place the spleen in a retrieval bag and to morcellate it prior to its removal through the largest port, while in patients with splenomegaly, the hand-assisted technique through a 7-8 cm supraumbilical midline incision was preferred (9). Suction drain was placed if pancreatic injury was suspected.…”

“…Suction drain was placed if pancreatic injury was suspected. Chen et al captured the spleen in an extraction bag, morcellated it with ring forceps and removed it through the left 10-12 mm orifice (9). A drain tube was routinely placed in all patients.…”