| Laparoscopic Splenectomy |
| |
 What
is Splenectomy? |
| What
are the Indications for Splenectomy |
| How
are these problems diagnosed? |
| How
is it done? |
| Open
method |
| Laparoscopic
method |
|
Before
the surgery |
|
During
the surgery |
|
After
the surgery |
| Benefits
and drawbacks |
| Complications |
|
| |
| What
is Splenectomy? |
| |
 Splenectomy
means surgical removal of spleen. The spleen is a blood
filled organ located in the upper left abdominal cavity.
It is a storage organ for red blood cells and contains
many specialized white blood cells called "macrophages"
(disease fighting cells) which act to filter blood. The
spleen is part of the immune system and also removes old
and damaged blood particles from your system. The spleen
helps the body identify and kill bacteria. |
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| What
are the Indications for Splenectomy? |
| |
| There are several reasons why a spleen
might need to be removed, and the following list, though
not all inclusive, includes the most common reasons. The
most common conditions that warrant Splenectomy in an
adult are: |
| |
- Trauma to the organ
- Blood disorders like Hemolytic anemia (a condition
that breaks down red blood cells)
- Enlarged spleen
- Benign tumors of the spleen
- Auto immune diseases of the spleen
- Spleenic cysts
- Selected leukemias or lymphomas that affect the
spleen
- Genetic conditions that affect shape of RBC, like
hereditary spherocytosis in which there are abnormally
sphere shaped red blood cells or Thalassemia major
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| |
|
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| How
are these problems diagnosed? |
| |
| An evaluation typically includes a
complete blood count (CBC), a visual look at the blood
cells placed on a glass slide called a 'smear', and often
a bone marrow examination. Sometimes an ultrasound examination
of your spleen, a computerized tomography (CT scan), magnetic
resonance imaging (MRI) or nuclear scan is needed. |
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|
|
|
| How
is it done? |
| |
| There are two ways to perform Splenectomy:
open or laparoscopic. But not all patients are candidate
for open method. Certain conditions like in cases of trauma
where intra-abdominal bleeding interferes with the surgeon's
ability to visualize the blood vessels, requires open
surgery. Spleens which are massively enlarged may also
pose a problem for the surgeon because the size of the
spleen restricts the visualization and manipulation of
the spleen. |
| |
| Sometimes the surgeon may decide to
convert the laparoscopic surgery to an open procedure
in certain situations and for patient safety. Though very
infrequent, when conversion to an open technique occurs,
it should not be considered a failure of the procedure.
In other situations, one of the small incisions may be
enlarged some for better handling of the spleen. This
is called 'laparoscopically assisted' or 'hand assisted
laparoscopic splenectomy' and is particularly helpful
in the very large spleens. |
| |
| Conventional
method or open method |
| |
| Traditionally, removal of the spleen
has been accomplished using one larger incision. Since
the cut is big, it takes more time to heal compared to
laparoscopic incision. Open Splenectomy would require
hospitalization for 3-7 days and 2-6 weeks for a full
recovery. |
| |
| Laparoscopic
method |
| |
| Laparoscopic or minimally invasive
approach involves specialized video equipment and instruments
that allow a surgeon to remove the spleen through several
tiny incisions, versus a traditional large midline incision
for an open approach. |
| |
| Before
the surgery |
| |
| After your surgeon reviews with you
the potential risks and benefits of the operation, you
will need to provide written consent for surgery. Your
surgeon may request that you completely empty your colon
and cleanse your intestines prior to surgery. You may
be requested to drink clear liquids, only, for one or
several days prior to surgery. |
| |
| The laparoscopic Splenectomy is usually
performed with general anesthesia. An IV line will be
placed in your arm for fluids and you will be brought
into the operating room. The anesthesiologist and nurses
will use monitors to check your heart rate and breathing
during the procedure. These may include EKG leads, a blood
pressure cuff, an oxygen mask and sleeves on your legs
to prevent clots from forming. |
| |
| During
the surgery |
| |
| The patient will be placed under general
anesthesia. A cannula (hollow tube) is placed into the
abdomen by the surgeon and the abdomen will be inflated
with carbon dioxide gas to create a space to operate.
A laparoscope (a tiny telescope connected to a video camera)
is put through one of the cannulas which project a video
picture of the internal organs and spleen on a television
monitor. Several cannulas are placed in different locations
on the abdomen to allow the surgeon to place instruments
inside your belly to work and remove the spleen. After
the spleen is cut from all that it is connected to, it
is placed inside a special bag. The bag with the spleen
inside is pulled up into one of the small, but largest
incisions on your abdomen. The spleen is broken up into
small pieces (morcelated) within the special bag and completely
removed. Laparoscopic splenectomy requires three or four
small incisions ranging from 1/4 to 1/2 inch. Additionally
there is a small incision usually 4-5 cm in length that
is used to extract the spleen |
| |
| In a small number of patients the
laparoscopic method cannot be performed. Factors that
may increase the possibility of choosing or converting
to the "open" procedure may include obesity,
a history of prior abdominal surgery causing dense scar
tissue, inability to visualize organs or bleeding problems
during the operation. The decision to perform the open
procedure is a judgment decision made by your surgeon
either before or during the actual operation. When the
surgeon feels that it is safest to convert the laparoscopic
procedure to an open one, this is not a complication,
but rather sound surgical judgment. |
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| After
the surgery |
| |
| After surgery you will be given intravenous
fluids (IV's) in your arm. You may have a stomach tube
coming up out your nose to prevent vomiting or stomach
bleeding because your stomach can fill up with stomach
juices and not empty properly after this surgery. Not
every surgeon uses this tube. You will be given pain medication
to relieve the discomfort you may experience from the
small incisions. You will need to let your nurse and surgeon
know what your pain medication needs are since everyone
has a different pain threshold. |
| |
| The surgery is done as an overnight
stay in most patients. The remaining patients typically
go home the following day. Patients can resume light daily
activity immediately. Most patients after laparoscopic
surgery will experience a sharp shoulder pain that resolves
after 2-4 hours. It is important that patients get out
of bed and go for a walk as soon as possible (the night
of surgery), to improve lung function and decrease the
risk of abnormal blood clots. The average patient will
require 1-2 weeks recovery before resuming more vigorous
activity. There is no forced limitation of activity, instead
patients are asked to advance their activity as tolerated.
This applies to the resumption of work, sports, and sexual
activity. |
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|
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| Benefits
and drawbacks |
| |
| Results may vary depending on your
overall condition and health. Usually laparoscopic method
has added benefits. They are: |
| |
- Less postoperative pain
- Shorter hospital stay
- Faster return to a regular, solid food diet
- Quicker return to normal activities
- Better cosmetic results
|
| The table given below compares the
laparoscopic and open surgery. |
| |
|
LAPAROSCOPIC
|
OPEN
|
|
Small Incisions (less than ½ an inch)
|
Large Incision
|
|
Hospital stay is 1 to 3 days
|
Hospital stay of about 5 days
|
|
Patients usually return to work in 5 to 10
days
|
Return to work in about 4 weeks
|
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Lesser risk of Infection
|
Greater risk of infection
|
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Less pain
|
More painful
|
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Less chance of hernias
|
More chance of hernias
|
|
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| Splenectomy, either open or laparoscopic,
is a safe procedure. But as with any other surgical procedure
however, complications may occur. The risk of surgery
is also related to the disease process for which the Splenectomy
is being performed. As with any other operation involving
the abdomen, injury to abdominal organs and tissues is
a potential risk. |
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| Complications |
| |
| Complications following laparoscopic
Splenectomy are infrequent, but you should consult your
doctor regarding possible complications based on your
specific case. Possible complications may include: |
| |
- Cannula site infections,
- Pneumonia,
- Internal bleeding or
- Infection inside the abdomen at the site where the
spleen used to be,
- The pancreas can become inflamed (pancreatitis).
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