It also makes immune system cells, called lymphocytes, which help fight germs and infections. The laparoscopic technique for splenectomy has become the preferred method for splenectomy at many institutions over the last 10 years. A hollow tube, which is a cannula will be placed inside the abdomen to inflate abdomen using carbon dioxide gas. Open splenectomy is performed in the supine position. Technique splenectomy of laparoscopic various approaches was described for laparoscopic splenectomy by the different authors. Oct 10, 20 since their introduction in the early 1990s, minimally invasive techniques have gained widespread acceptance because of the significant benefits that patients are able to experience. Laparoscopic splenectomy should therefore be considered the technique of choice and should prompt earlier consideration of surgery for patients with selected hematologic disorders. Handassisted laparoscopic surgery hals is another technique for laparoscopic splenectomy that offers benefits of both open and laparoscopic techniques and has proved beneficial.
The aim of this study was to evaluate the efficacy of ls in a large cohort of. Procedure was performed in the department of pediatric surgery in zabrze, medical university of silesia, poland. Atlas of advanced operative surgery 1st edition pdf free. Division of the phrenocolic ligament, mobilization of the lower pole of the spleen 3. Laparoscopic splenectomy international surgery journal. Laparoscopic splenectomy was completed successfully in 143 97.
Absolute and relative contraindications for laparoscopic splenectomy are listed in table 1. Complications of laparoscopic splenectomy minimally. A twostep control of secondary splenic pedicles using. The splenic artery and vein are exposed near the hilum, using a laparoscopic ultrasonic dissector. Jan 30, 2020 indications for laparoscopic splenectomy are the same as those for open splenectomy except when emergency splenectomy and exploratory laparotomy for traumatic injuries are needed. A telescope with a video camera shows everything inside the abdomen on a television screen in the operating room. This article details the technique and reports the results of 63 infants, children, and adolescents who underwent laparoscopic splenectomy for hematologic disorders. For large spleens and early in the experience of surgeons undertaking laparoscopic splenectomy, a handassisted technique may reduce. Advance your surgical expertise with atlas of advanced operative surgery. Frequently asked questions about laparoscopic splenectomy. However, from the patients perspective, open surgery creates a great deal of trauma. For the lateral approach, the operation begins with safe laparoscopic abdominal access. Laparoscopic splenectomy ls suffers from several technical.
This has been extremely successful and has given an excellent result in our small series. Pain experienced by the open technique is greater and longer lasting. Laparoscopic spleen removal splenectomy clearwater. Laparoscopic splenectomy in patients with hematologic. Full text full text is available as a scanned copy of the original print version. Laparoscopic splenectomy was first documented by delaitre and maignien in 1991. Download files by right click and save target as please keep patience. Splenectomy through laparoscopic approach is an effective technique. Laparoscopic splenectomy in child vessels first technique. Feb 10, 2011 laparoscopic splenectomy george ferzli, md, facs department of laparoscopic surgery staten island university hospital slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. For these reasons, since its first description by delaitre and. It removes old and damaged blood cells as blood passes through it.
Though the experience of the surgeon is the biggest factor in a successful outcome, the size of the spleen is the most important determinant in deciding whether the spleen can be removed laparoscopically. Since their introduction in the early 1990s, minimally invasive techniques have gained widespread acceptance because of the significant benefits that patients are able to experience. Pdf laparoscopic splenectomy ls is the second level of skill for a surgeon. This material is provided for educational purposes only. Laparoscopic splenectomy george ferzli, md, facs department of laparoscopic surgery staten island university hospital slideshare uses cookies to improve functionality and performance. The donor operation will be performed using the laparoscopic technique. We modified the ligasure vessel sealing into a twostep technique without using endogia stapler for the secondary splenic pedicle control in laparoscopic splenectomy ls. Procedure was performed in the department of pediatric surgery in. Your spleen is located to the left of your stomach. Feb 03, 2020 laparoscopic splenectomy is surgery to take out all or a part of your spleen. The splenic artery and vein are exposed near the hilum. Laparoscopic splenectomy requires careful identification and ligation of the various ligaments that surround the spleen. The approach is determined by the disease process and clinical stability of the patient. Get a printable copy pdf file of the complete article 1.
Therapeutic platelet response to splenectomy occurred in 82% of patients with immune thrombocytopenic purpura and hematocrit level increased in 60% of patients with autoimmune hemolytic anemia undergoing successful laparoscopic splenectomy. Splenectomy the operation is the same on the inside. This study evaluated the efficacy and safety outcomes of this technique. This is a direct consequence of referral pattens within our centers. Laparoscopic splenectomy in patients with hematologic diseases. Laparoscopic splenectomy in a case of blunt abdominal trauma. Manual of the european association of endoscopic surgery. Free operative study material pdf slides opearive technique. The aim of this paper is to compare the results of. Indications for nontrauma laparoscopic splenectomy.
Laparoscopic splenectomy inpatient care what you need to know. Most cases require splenectomy can be treated laparoscopically. Laparoscopic splenectomy using the suspended pedicle technique. Laparoscopic splenectomy ls suffers from several technical problems for mobilization and manipulation of a solid organ. Traditionally, removal of the spleen accomplished by one large commonly a left subcostal or a left upper paramedian incision. We have retrospectively compared the effectiveness and safety of these approaches in patients with nonsevere splenomegaly scheduled for elective total ls. Laparoscopic splenectomy was attempted in 43 patients and successfully completed in 35 81%. The blood flowing to the the spleen is as a result diverted to the liver, this enhances its healing. Pereira is a big factor in a successful outcome, the size of the spleen is the most important determinant in deciding whether the spleen can be removed laparoscopically. If you have a question about your need for a laparoscopic splenectomy, your. Laparoscopic splenectomy is indicated for various benign hematologic diseases, malignant hematologic diseases, secondary hypersplenism, and other anatomic disorders. Lateral dissection of the vessels provides less operative complications in children. Laparoscopic splenectomy for a ruptured spleen has been reported only in a few cases, in which a handassisted technique was used.
Introduction n owadays, laparoscopy is the standard approach to performsplenectomyinchildren. Jan 30, 2020 handassisted laparoscopic surgery hals is another technique for laparoscopic splenectomy that offers benefits of both open and laparoscopic techniques and has proved beneficial in patients with splenomegaly craniocaudal length 22 cm or width 19 cm. Spleen was delivered enblock from a fanestiel incision. A technique for laparoscopic splenectomy is described. Patient engagement patient education 116,890 views. Laparoscopic splenectomy aftercare instructions what. Laparoscopic vs open splenectomy minimally invasive. Although the anterior approach is normally used for elective laparoscopic splenectomy ls, the posterolateral approach may be superior.
Laparoscopic vs open splenectomy minimally invasive surgery. Laparoscopic splenectomy is a useful method for reducing hospital stay, complications and return to normal activity. The development of technology and the introduction of new alternatives to classic laparoscopic splenectomy such as the singleport procedure. The success of laparoscopic cholecystectomy has favored the application of this technique in abdominal surgery. Clinical response itp after laparoscopic splenectomy. Some of these benefits include reduced postoperative pain, earlier return to normal activity, and improved cosmesis when compared with open surgery. Complications following laparoscopic splenectomy are infrequent, but you should consult your doctor regarding possible complications based on your specific case. The advantages of laparoscopic splenectomy include a shortened postoperative hospitalization, improved cosmesis, and less analgesic requirements. Flowers jl, lefor at, steers j, heyman m, graham sm, imbembo al.
Thrombocytopenia is not a contraindication of splenectomy. Laparoscopic for splenectomy general anesthesia is needed to be given to the candidate, before the surgery is started and the patient will be asleep. Care guide for laparoscopic splenectomy inpatient care. The cosmetic results of four small incisions made with the laparoscopic approach are more pleasing than the one large incision used for. Feb 06, 2017 splenectomy is also indicated in patients who recur after cessation of therapy. Specific recommendations may vary among health care professionals. The advantages of laparoscopic splenectomy include a shortened. Laparoscopic splenectomy ls is an accepted procedure for elective splenectomy. Emmermann a, zornig c, peiper m, weh hj, broelsch ce. The patient is placed on the operating room table in the right lazy decubitus position using a bean bag with the right arm.
The blood supply to the spleen is tied and divided. With this technique, the vessels are ligated as they terminate into the spleen. The recipient operation will be performed in the standard fashion with the addition of a laparoscopic splenectomy when. Laparoscopic management of splenomegaly entails a more demanding technique, and manipulation of a large organ and extraction of the viscera may be more difficult. The cosmetic results of four small incisions made with the laparoscopic approach are more pleasing than the one large incision used for the open technique. Atlas of advanced operative surgery 1st edition pdf. Laparoscopic splenectomy inpatient care what you need. Splenectomies may be performed via open or laparoscopic technique. Society of american gastrointestinal and endoscopic surgeons sages 4,927 views. The film presents laparoscopic splenectomy in child with congenital spherocytosis.
Depending on the surgical team and the chosen laparoscopic technique, usually four or five ports suffice for a splenectomy, with one for the laparoscopic camera tube, and only one of any size possibly a few centimeters to allow for removal of spleen tissue. The aim of this paper is to present the technique and the tricks for a. Laparoscopic splenectomy for secondary cytoreduction of. Your spleen is a beanshaped organ found under your ribs on the left upper side of your abdomen stomach. Spleen disease how is laparoscopic splenectomy performed.
This can be accomplished with an open or a closed technique, in accordance with the skill, experience, and comfort level of the surgeon. The patient is placed on the operating room table in the right lazy decubitus position using a bean bag with the right arm abducted and the left arm adducted anterior and superior. The gastrosplenic ligament contains the short gastric vessels and must be divided to obtain access to the splenic vessels, whereas the splenophrenic and splenorenal ligaments are relatively avascular. Advancement in technology has extended the possibility of ls. Laparoscopic splenectomy is surgery to take out all or a part of your spleen. Indications for laparoscopic splenectomy are the same as those for open splenectomy except when emergency splenectomy and exploratory laparotomy for traumatic injuries are needed. As a part of ongoing research process, we are doing laparoscopic splenectomy in patients with early liver diseases. Laparoscopic splenectomy is a safe procedure, and can provide less postoperative morbidity in experienced hands, as open splenectomy.
Splenectomy is also indicated in patients who recur after cessation of therapy. The purpose of this video is to demonstrate a step. Laparoscopic splenectomy is a potential surgical option for the treatment of isolated gynecologic cancer recurrence to the spleen 17. Laparoscopic removal of an enlarged spleen pro diagnosi. The thin fibrous attachments between the spleen and the diaphragm are divided. The purpose of this video is to demonstrate a stepbystep approach for laparoscopic splenectomy in the setting of recurrent, oligometastatic ovarian cancer. Splenectomy, laparoscopic splenectomy, open splenectomy, laparoscopic versus open splenectomy. Splenectomy is indicated when medical treatment failed clinical response itp after laparoscopic splenectomy 84. The speed of this technique varies depending on the man ner of ligation used, with the use of a ves. Nov 01, 2015 spleen removal surgery laparoscopic splenectomy preop patient education duration. Laparoscopic splenectomy using conventional instruments. Jan 23, 2017 laparoscopic splenectomy is done using an instrument called a laparoscope. Lateral approach has been proposed as an alternative to the anterior approach which facilitates ls. Laparoscopic splenectomy ls has gradually become the technique of choice for surgical removal of the spleen.
After getting enough exposure from the hilum of spleen, securing vascular pedicle an. This new resource picks up where other surgical references leave off. In a small number of patients the laparoscopic method cannot be performed. When the size of the spleen is extremely large, it is difficult to perform the.
Splenectomy open and laparoscopic techniques basicmedical key. Therapeutic platelet response to splenectomy occurred in 82% of patients with immune. Laparoscopic splenectomy 34 small incisions are made, each about. The patient is placed in the right semidecubitus position and pneumoperitoneum is prepared.
Lateral approach for laparoscopic splenectomy annals of. Depending on the surgical team and the chosen laparoscopic technique, usually four or five ports suffice for a splenectomy, with one for the laparoscopic camera tube, and only one of any size possibly a few. The abdominal cavity is filled with carbon dioxide gas to create a space to work in. A hollow tube, which is a cannula will be placed inside. This new resource picks up where other surgical references leave off, providing highly visual, stepbystep guidance on more than 100 advanced and complex procedures in both general and subspecialty areas. When the size of the spleen is extremely large, it is difficult to perform the laparoscopic. Even with these advances, laparoscopic splenectomy in patients on dialysis can be difficult. Step by step explanation and demonstration of surgical, gynaecological and urological laparoscopic operative procedures.
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