Laparoscopic splenectomy using conventional instruments

Abstract

Introduction:Laparoscopic splenectomy (LS) is an accepted procedure for elective splenectomy. Advancement in technology has extended the possibility of LS in massive splenomegaly [Choy et al., J Laparoendosc Adv Surg Tech A 14(4), 197–200 (2004)], trauma [Ren et al., Surg Endosc 15(3), 324 (2001); Mostafa et al., Surg Laparosc Endosc Percutan Tech 12(4), 283–286 (2002)], and cirrhosis with portal hypertension [Hashizume et al., Hepatogastroenterology 49(45), 847–852 (2002)]. In a developing country, these advanced gadgets may not be always available. We performed LS using conventional and reusable instruments in a public teaching the hospital without the use of the advanced technology. The technique of LS and the outcome in these patients is reported.Materials and Methods:Patients undergoing LS for various hematological disorders from 1998 to 2004 were included. Electrocoagulation, clips, and intracorporeal knotting were the techniques used for tackling short-gastric vessels and splenic pedicle. Specimen was delivered through a Pfannensteil incision.Results:A total of 26 patients underwent LS. Twenty-two (85%) of patients had spleen size more than 500 g (average weight being 942.55 g). Mean operative time was 214 min (45–390 min). The conversion rate was 11.5% (n = 3). Average duration of stay was 5.65 days (3–30 days). Accessory spleen was detected and successfully removed in two patients. One patient developed subphrenic abscess. There was no mortality. There was no recurrence of hematological disease.Conclusion:Laparoscopic splenectomy using conventional equipment and instruments is safe and effective. Advanced technology has a definite advantage but is not a deterrent to the practice of LS.

The Role of Pre-emptive Control of Vascular Pedicle in Laparoscopic Splenectomy: An Experience with 19 Consecutive Patients

“…12 Several operative approaches are in practice to access the splenic vessels prior to mobilization of the spleen to minimize bleeding during surgery. [13][14][15][16][17][18] Ligation of splenic vessels prior to splenic mobilization allowed partial emptying of the spleen, thus diminishing its size, facilitating auto transfusion, and decreasing the risk of hemorrhage as concluded by several authors. [19][20][21][22][23] Asoglu et al reported effective control of intraoperative bleeding with no extension of the operative time and low conversion rate during laparoscopic splenectomy with early ligation of the splenic artery before splenic lysis.…”

Laparoscopic splenectomy using bipolar vessel sealing system

“…the bleeding is either from capsule or from the splenic vessels which are more prone for injury during dissection of splenic vessels which is used in all studies mentioned above except in F.Romano et al study who used only ligasure as we did in our study. In our study we use small Pfannenstiel incision to retrieve spleen from abdominal cavity, that was the same way used by Ahmed nada et al (20) and A.N.Dalvi et al (24) . in 3 of our patients we used retrieval bag to retrieve the spleen from site of 10mm port this method used by F.Romano et al (23) patients and in his study he explain that the cause of conversion due to position because most of conversions occur in patients who operated in supine position .…”

Splenectomy in Special Cases

“…This technique is used even in the case of splenomegaly operated laparoscopically with blood vessels with diameters above 7 mm, because after the ligation of the splenic artery, the blood flow is much reduced, especially if the short vessels of the gastrosplenic ligament are cut shortly afterwards. For the hilum vessels section there is the alternative to use vascular staplers [16,17], conventional ligatures [18] or hemoclips [19]. We preferred vascular sealing devices that can cut the vessels near the surface of the spleen, without damaging the pancreatic tissue, swollen, infiltrated with blood in this case.…”