Laparoscopic surgery of the spleen: State of the art

Adrian Park, Eduarde M. Targarona, Manuel Trías

Research output: Contribution to journalReview article

Abstract

Introduction: Laparoscopic splenectomy (LS) offers superior visualization and access to the spleen and avoids the major laparo-tomy incision necessary in open splenectomy (OS). This review summarizes the current knowledge of laparoscopic techniques for splenectomy from the perspective of surgeons whose combined experience now totals 340 cases. Background and discussion: While LS has been applied across the spectrum of splenic diseases, it is most indicated in treatment of a benign hematologic condition with a normal or slightly enlarged spleen as seen in autoimmune thrombocytopenic purpura (ITP), autoimmune deficiency syndrome-related ITP, hemolytic anemia, or spherocytosis. Both anterior and lateral approaches have been used for LS. While benefits of the anterior approach include access to the splenic artery along the superior border of the pancreas within the lesser sac, thus securing vascular control early in the procedure, the lateral approach allows for improved exposure of and access to the splenic pedicle. Also, mechanics and sequence of dissection are enhanced and more intuitive to the surgeon using the lateral approach, and the tail of the pancreas is more easily identified. Potential perioperative complications of LS include hemorrhage, injury to the tail of the pancreas, and deep vein thrombosis. The most common criticisms facing LS are the potential for missed accessory spleens, longer operating time, and greater operating room costs compared to OS. However, while LS requires a longer operating time than OS, studies indicate shorter postoperative hospital stays for LS versus OS patients in comparable cases, which can, in turn, reduce the total hospital cost for the procedure. Conclusion: Although LS continues to pose certain technical challenges - such as management of the massive spleen, specimen extraction, and identification of remotely located accessory spleens - its advantages over OS in terms of faster postoperative recovery, shorter hospital stay, and equivalent or lower perioperative morbidity are now well established. Indications for LS and more laparoscopic spleen-conserving surgery are likely to broaden.

Original languageEnglish (US)
Pages (from-to)230-239
Number of pages10
JournalLangenbeck's Archives of Surgery
Volume386
Issue number3
DOIs
StatePublished - May 21 2001
Externally publishedYes

Fingerprint

Splenectomy
Laparoscopy
Spleen
Pancreas
Idiopathic Thrombocytopenic Purpura
Length of Stay
Splenic Diseases
Splenic Artery
Hospital Costs
Hemolytic Anemia
Splenomegaly
Peritoneal Cavity
Operating Rooms
Mechanics
Venous Thrombosis
Blood Vessels
Dissection

Keywords

  • Accessory spleen Splenomegaly
  • Autoimmune thrombocytopenic purpura (ITP)
  • Laparoscope
  • Laparoscopic splenectomy
  • Splenic hilum

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic surgery of the spleen : State of the art. / Park, Adrian; Targarona, Eduarde M.; Trías, Manuel.

In: Langenbeck's Archives of Surgery, Vol. 386, No. 3, 21.05.2001, p. 230-239.

Research output: Contribution to journalReview article

Park, Adrian ; Targarona, Eduarde M. ; Trías, Manuel. / Laparoscopic surgery of the spleen : State of the art. In: Langenbeck's Archives of Surgery. 2001 ; Vol. 386, No. 3. pp. 230-239.
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abstract = "Introduction: Laparoscopic splenectomy (LS) offers superior visualization and access to the spleen and avoids the major laparo-tomy incision necessary in open splenectomy (OS). This review summarizes the current knowledge of laparoscopic techniques for splenectomy from the perspective of surgeons whose combined experience now totals 340 cases. Background and discussion: While LS has been applied across the spectrum of splenic diseases, it is most indicated in treatment of a benign hematologic condition with a normal or slightly enlarged spleen as seen in autoimmune thrombocytopenic purpura (ITP), autoimmune deficiency syndrome-related ITP, hemolytic anemia, or spherocytosis. Both anterior and lateral approaches have been used for LS. While benefits of the anterior approach include access to the splenic artery along the superior border of the pancreas within the lesser sac, thus securing vascular control early in the procedure, the lateral approach allows for improved exposure of and access to the splenic pedicle. Also, mechanics and sequence of dissection are enhanced and more intuitive to the surgeon using the lateral approach, and the tail of the pancreas is more easily identified. Potential perioperative complications of LS include hemorrhage, injury to the tail of the pancreas, and deep vein thrombosis. The most common criticisms facing LS are the potential for missed accessory spleens, longer operating time, and greater operating room costs compared to OS. However, while LS requires a longer operating time than OS, studies indicate shorter postoperative hospital stays for LS versus OS patients in comparable cases, which can, in turn, reduce the total hospital cost for the procedure. Conclusion: Although LS continues to pose certain technical challenges - such as management of the massive spleen, specimen extraction, and identification of remotely located accessory spleens - its advantages over OS in terms of faster postoperative recovery, shorter hospital stay, and equivalent or lower perioperative morbidity are now well established. Indications for LS and more laparoscopic spleen-conserving surgery are likely to broaden.",
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