Laparoscopic splenectomy: the latest technical evaluation

Abstract

Most cases of LS could be accomplished successfully when patients are placed in the right lateral position. The right lateral position has more advantages than the conventional supine approach by providing a more direct view of the splenic hilum as well as other important anatomies. Regardless of operation positions, the major axis of spleen exceeding 15 cm by B-ultrasound in vitro will surely increase the difficulties of LS and therefore prolong the duration of operation. LS is a safe and feasible modality for splenectomy.

Outpatient laparoscopic splenectomy: patient safety and satisfaction

“…But it is imperative to recognize unusual vascular anatomy before any bleeding is generated; and in our hands, this still requires 2 h in the most prolonged procedures. These are patients with splenomegaly, who can be operated on laparoscopically [22][23][24], but the reduced intraabdominal space makes the dissection around the splenic structures more difficult. Some authors recommend a hand-assisted technique in this situation [20], and even this technique might be tried in an outpatient setting.…”

Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

“…Immunoglobulins may be an effective but costly alternative and are related to more unwanted side affects. Immunoglobulin G (e.g., 400 mg/kg/day) may be administered for 3 to 5 days at least 1 week before surgery to raise the platelet count to a mean value of 50 [104] or 80 9 10 9 /l [105]. In cases of anemia, preoperative transfusions of packed erythrocytes to raise hemoglobin to levels exceeding 10 g/dl are advisable.…”

“…This position allows for good access to the omental pouch and excellent visualization of the splenic hilum [104,114]. Difficulties arise in exposing and dissecting the ligamental structures as well as the dorsal vessels and the splenic hilum, with its close relationship to the tail of the pancreas [105].…”

“…The anterior or ''supine'' position was applied mostly in the early years of LS [4,104,105]. This position allows for good access to the omental pouch and excellent visualization of the splenic hilum [104,114].…”

Laparoscopic Splenectomy in Patients with Haematological Disorders: A Prospective Study

“…Laparoscopic splenectomy is a procedure of high complexity, whose technical difficulty is directly related to the presence of adhesions to other organs and the relative size of the spleen [11] . Advances in surgical technique, operative conduct, and instrumentation…”