Laparoscopic surgery of the spleen: State of the art

Adrian Park, Eduarde M. Targarona, Manuel Trías

Producció científica: Contribució a revistaArticle de revisióRecercaAvaluat per experts

59 Cites (Scopus)

Resum

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.
Idioma originalAnglès
Pàgines (de-a)230-239
RevistaLangenbeck's Archives of Surgery
Volum386
Número3
DOIs
Estat de la publicacióPublicada - 21 de maig 2001

Fingerprint

Navegar pels temes de recerca de 'Laparoscopic surgery of the spleen: State of the art'. Junts formen un fingerprint únic.

Com citar-ho