For these reasons, since its first description by delaitre and. The laparoscopic splenectomy proved to be a safe procedure, usually. The goal in laparoscopic splenectomy is to perform a safe splenectomy while mini. Feb 06, 2017 splenectomy is also indicated in patients who recur after cessation of therapy. The objective of this study was to compare single sils with three portal conventional laparoscopic splenectomy in dogs. Advance your surgical expertise with atlas of advanced operative surgery. Although, laparoscopic splenectomy is the preferred technique for the elective removal of normalsized and moderately enlarged spleens, in infant, it is a value to avoid a larger spleen in the management of splenomegaly for surgeons with advanced laparoscopic technique.
Finally, a laparoscopic splenectomy requires the surgeon to have advanced laparoscopic skills and therefore it may be underutilized. An increased technical skill among surgeons has extended the application for laparoscopic splenectomy to safely include patients with massive splenomegaly. Division of the phrenocolic ligament, mobilization of. Society of american gastrointestinal and endoscopic surgeons sages 4,927 views. Splenectomy is indicated when the tumor is large, with increased risk of hemorrhage. Throughout the nearly last three decades, different approaches have been described since delaitre and maignien reported the first minimally invasive splenectomy in 1991. Journal of the society of laparoendoscopic surgeons society of laparoendoscopic surgeons 81. This has been extremely successful and has given an excellent result in our small series. We recently reported a combined laparoscopic splenectomy and colectomy for unrelated pathologies including sigmoid diverticulitis and granulomatous splenic lesions due to sarcoidosis. 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. Laparoscopic versus open splenectomy world laparoscopy hospital.
The blood supply to the spleen is tied and divided. Ls in comparison with open surgery offers the same efficacy in the control of hematologic disease with the additional benefits of a minimally invasive approach. A novel technique for synchronous laparoscopic splenectomy. Laparoscopic splenectomy for immune thrombocytopenic. Splenectomy open and laparoscopic techniques basicmedical key. A series of 103 consecutive adult patients underwent ls between 1992 and 1997 at our teaching hospital. Jan 23, 2017 laparoscopic splenectomy is done using an instrument called a laparoscope. Laparoscopic splenectomy for secondary cytoreduction of. Laparoscopic splenectomy for spontaneous rupture of the spleen. Surgical technique lateral approach for laparoscopic splenectomy sonia fernandezananin1, carmen balague ponz 1, antonello forgione2, eduardo m. The thin fibrous attachments between the spleen and the diaphragm are divided. 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. Lateral approach for laparoscopic splenectomy laparoscopic surgery has become the standard treatment for both benign and malignant diseases of the spleen that require splenectomy.
Recently, laparoscopic conservative techniques have been proposed. For these reasons, since its first description by delaitre. Complications of laparoscopic splenectomy minimally. Spleen was delivered enblock from a fanestiel incision. Splenic retrieval following laparoscopic splenectomy. Laparoscopic splenectomy is a potential surgical option for the treatment of isolated gynecologic cancer recurrence to the spleen 17. Approximately 600 cases have been reported, with the largest individual series comprising 70 cases, including a partial splenectomy. Step by step explanation and demonstration of surgical, gynaecological and urological laparoscopic operative procedures.
Laparoscopic splenectomy should be the treatment of choice for patients with itp who require splenectomy. Laparoscopic splenectomy is safe and effective for the management of itp and allows rapid recovery. Division of the phrenocolic ligament, mobilization of the lower pole of the spleen 3. Splenectomy, laparoscopic splenectomy, open splenectomy, laparoscopic versus open splenectomy. A 72yearold male patient presented with mds associated itp and splenomegaly and a bleeding colon cancer. Laparoscopic splenectomy is now becoming the pro cedure of choice for elective splenect omy wherever the expertise. Absolute and relative contraindications for laparoscopic splenectomy are listed in table 1. Laparoscopic splenectomy is surgery to take out all or a part of your spleen. Thanks to its lowinvasiveness and cosmetic superiority, most splenectomy is now performed under laparoscopy. The surgery was accomplished within acceptable time span and minimum usage of advanced gadgets, emphasizing feasibility of laparoscopy in presence of haemorrhage. Technique splenectomy of laparoscopic various approaches was described for laparoscopic splenectomy by the different authors.
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. Splenectomy is also indicated in patients who recur after cessation of therapy. Laparoscopic splenectomy ls is the second level of skill for a surgeon. Indications and technique article pdf available in jsls. Download files by right click and save target as please keep patience. The approach is determined by the disease process and clinical stability of the patient. Laparoscopic splenectomy international surgery journal. In order to ensure that usersafety is not compromised and you enjoy faster downloads, we have used trusted 3rdparty repository links that are not hosted on our website. The indications for splenectomy included idiopathic thrombocytopenic purpura itp.
Operative techniques in surgery 2 volume set pdf free download. Elective laparoscopic splenectomy for giant hemangioma. Laparoscopic splenectomy for trauma, shamim aa et al. Laparoscopic splenectomy ls, first described in 1991, is often the preferred approach in an elective setting. Concepts and techniques in laparoscopic splenectomy sages. Alternative incision to remove larger spleen in laparoscopic. Atlas of advanced operative surgery 1st edition pdf. Apr 15, 2016 objective to describe the operative technique and perioperative outcome for laparoscopic assisted splenectomy las in dogs. It removes old and damaged blood cells as blood passes through it. Chemical splenectomy indications for splenectomy splenectomy and the h. Although technically feasible, laparoscopic splenectomy can be a challenge in the patient with splenomegaly. The laparoscopic approach is preferred for most elective splenectomies. Since 1991 when it was first described by delaitre, 1 the laparoscopic approach has become the standard technique for most cases of elective splenectomy. The advantages of laparoscopic splenectomy include a shortened postoperative hospitalization, improved cosmesis, and less analgesic requirements.
Laparoscopic splenectomy journal of laparoendoscopic. In laparoscopic splenectomy, the spleen is placed into a. Laparoscopic management of splenomegaly entails a more demanding technique, and manipulation of a large organ and extraction of the viscera may be more difficult. Splenectomy is indicated when medical treatment failed clinical response itp after laparoscopic splenectomy 84. In laparoscopic splenectomy, the spleen is placed into a small bag inside the abdominal cavity and. We employed a safe approach during laparoscopic splenectomy by first mobilizing the pancreatic tail and then dissecting the splenic vessels at the splenic hilum before mobilizing the spleen. The described technique allows laparoscopic splenectomy to be performed in an. Traditionally, removal of the spleen accomplished by one large commonly a left subcostal or a left upper paramedian incision. Atlas of advanced operative surgery 1st edition pdf free. Splenectomies may be performed via open or laparoscopic technique. 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. Your spleen is a beanshaped organ found under your ribs on the left upper side of your abdomen stomach. Procedure was performed in the department of pediatric surgery in zabrze, medical university of silesia, poland. This positioning allows gravity to assist in the dissection of the splenic attachments and it.
Combined laparoscopic colectomy and splenectomy for. Laparoscopic splenectomy ls is applied to various diseases such as splenic tumor, liver cirrhosis, and idiopathic thrombocytopenic purpura itp for treatment and to homological diseases for diagnosis. 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. Patients were placed in the lithotomy position, and only the upper body was twisted to the right side. Splenectomy together with colectomy is most commonly performed as a result of iatrogenic injury and not as an additional elective procedure. Indications of laparoscopic splenectomy are the same as in the open technique. Laparoscopic splenectomy is a wellestablished surgical technique for elective splenectomy and was offered in this patient who presented with hemoperitoneum due to srs. Free operative study material pdf slides opearive technique. Safe approach to the splenic hilum by first mobilizing the.
It also makes immune system cells, called lymphocytes, which help fight germs and infections. Comparison between single and three portal laparoscopic. Indications for laparoscopic splenectomy are the same as those for open splenectomy except when emergency splenectomy and exploratory laparotomy for traumatic injuries are needed. Although ls seems easy and simple, there are some concepts and. Pain experienced by the open technique is greater and longer lasting. Concepts and techniques in laparoscopic splenectomy. Therapeutic laparoscopy, especially splenectomy in a trauma setting, is controversial. Operative techniques in surgery 2 volume set pdf free. The blood flowing to the the spleen is as a result diverted to the liver, this enhances its healing. A hollow tube, which is a cannula will be placed inside the abdomen to inflate abdomen using carbon dioxide gas. The film presents laparoscopic splenectomy in child with congenital spherocytosis.
As a part of ongoing research process, we are doing laparoscopic splenectomy in patients with early liver diseases. 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. After getting enough exposure from the hilum of spleen, securing vascular pedicle an. The aim of this paper is to present the technique and the tricks for a succesfull splenectomy. With increasing experience, operative times decrease. Single incision laparoscopic surgery sils is a newly growing technique to replace a more invasive conventional multiple portal laparoscopic surgery. Gynaecological and urological laparoscopic operative procedures. Kercher kw, matthews bd, walsh rm, sing rf, backus cl, heniford bt. 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. Combined splenectomy with resection of left colon, sigmoid colon or rectum is usually due to injury of the spleen causing uncontrollable hemorrhage during mobilization of the splenic flexure.
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. The laparoscopic technique for splenectomy has become the preferred method for splenectomy at many institutions over the last 10 years. 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. To study the safety and efficacy of laparoscopic splenectomy ls in patients with hematologic disorders requiring surgical intervention patients and methods. Laparoscopic for splenectomy general anesthesia is needed to be given to the candidate, before the surgery is started and the patient will be asleep. Laparoscopic splenectomy was first described in 1992 by several different authors. Laparoscopic splenectomy using the suspended pedicle technique. Laparoscopic splenectomy for a ruptured spleen has been reported only in a single case, in which a handassisted technique was used. The purpose of this video is to demonstrate a stepbystep approach for laparoscopic splenectomy in the setting of recurrent, oligometastatic ovarian cancer. In the 1995, kusminsky et al 4 introduced the handassisted laparoscopic technique as an adjunct to laparoscopic splenectomy. We present the first reported case, to our knowledge, of successful removal of a ruptured spleen by means of a totally laparoscopic technique. Combined laparoscopic colectomy and splenectomy for bleeding. The introduction of laparoscopy in the early 1990s had given a new era in the surgical treatment of human diseases, laparoscopic surgery is a wellestablished alternative to open surgery across disciplines.
There are also presented some datas of history of spleen surgery and surgical anatomy. Lateral approach for laparoscopic splenectomy fernandez. Laparoscopic splenectomy for immune thrombocytopenic purpura. Some of these benefits include reduced postoperative pain, earlier return to normal activity, and improved cosmesis when compared with open surgery. Handassisted laparoscopic surgery hals uses a port large enough to accommodate the. Handassisted laparoscopic splenectomy vs conventional laparoscopic splenectomy in cases of splenomegaly. One frustrating aspect of the procedure is removal of the spleen. To investigate the safety and feasibility of synchronous laparoscopic splenectomy and azygoportal disconnection with hepatectomy lsdh for treatment of portal hypertension accompanied with hcc, we describe a clinical cohort of 10 patients who underwent a new technique of synchronous lsdh. Although unusual, hemangioma is the most common primary splenic neoplasm.
Splenectomy the operation is the same on the inside. Spleen disease how is laparoscopic splenectomy performed. The technique of laparoscopic splenectomy ls was first described in 1992 2, 6 and has become a wellaccepted procedure. Laparoscopic splenectomy should therefore be considered the technique of choice and should prompt earlier consideration of surgery for patients with selected hematologic disorders. Laparoscopic splenectomy is indicated for various benign hematologic diseases, malignant hematologic diseases, secondary hypersplenism, and other anatomic disorders of the spleen. In this blog post, we are going to share a free pdf download of operative techniques in surgery 2 volume set pdf using direct links. Laparoscopic splenectomy in child vessels first technique.
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