Laparoscopic Splenectomy

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Benign hematologic conditions: Immune thrombocytopenic purpura, hereditary spherocytosis, hemolytic anemia due to erythrocyte enzyme deficiency, hemoglobinopathies
  • Miscellaneous benign conditions: Splenic cysts, abscess, wandering spleen
CONTRAINDICATIONS
  • Severe cardiopulmonary disease
  • Cirrhosis, portal hypertension, and variceal short gastric vessels
  • Pregnancy
  • Massive splenomegaly (relative)
  • Hematologic malignancies (relative)
EQUIPMENT
  • Anesthetic equipment
  • Operating table
  • Instrument table
  • Electrocautery device
  • Laparoscopic unit
  • Video monitors
ANATOMY
  • Pancreaticosplenic ligament: Attaches the posterior margin of the hilum to the tail of the pancreas and to the splenic vessels.
  • Gastrosplenic ligament: Attaches the anterior margin of the hilum to the greater curvature of the stomach. It contains the short gastric vessels and the gastroepiploic artery.
  • Phrenicosplenic ligament: Attaches the superior pole of the hilum to the diaphragm and the anterior aspect of the left kidney.
  • Splenocolic ligament: Attaches the base of the hilum to the left transverse mesocolon and to the splenic flexure.
  • Phrenicocolic ligament: Attaches the left flexure of the colon and the diaphragm to the lower extremity of the spleen.
  • The splenophrenic and splenocolic ligaments are relatively avascular.
  • The splenic artery arises from the celiac trunk; it has a tortuous course along the superior border of the pancreas. The branches of the splenic artery include the numerous pancreatic branches, the short gastric arteries, the left gastroepiploic artery, and the terminal splenic branches. The splenic artery divides into several branches within the splenorenal ligament before entering the splenic hilum, where they branch again as they enter the splenic pulp.
  • The splenic vein runs inferior to the artery and posterior to the pancreatic tail and body. It receives several short tributaries from the pancreas. The splenic vein joins the superior mesenteric vein at a right angle behind the neck of the pancreas to form the portal vein.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Monitor bleeding.
  • If the platelet count increases to more than 1 million, aspirin can be given.
  • Children should receive maintenance antibiotic treatment until age 18 years.
  • Discuss medical alert bracelet.
  • Ensure vaccinations given or plan to be given against Haemophilus influenzae, meningococcus, and pneumococcus.
  • Script for antibiotics (usually penicillin or erythromycin if allergic) to take as soon as any sign of illness or prophylaxis before dental work or surgical procedures of any kind.
  • Malaria precaution if traveling.
  • Pain control.
  • Progressive increase in activity.
  • Usually earlier discharge from hospital.
COMPLICATIONS
  • Bleeding: Higher risk in those with myeloproliferative disorders
  • Postsplenectomy thrombocytosis: Higher risk in those with myeloproliferative disorders
  • Left lower lobe atelectasis, pneumonia, and pleural effusion
  • Wound infection
  • Incisional hernia
  • Subphrenic abscess
  • Pancreatic fistula/pseudocyst
  • Gastric fistula/perforation
  • Overwhelming postsplenectomy infection: Risk is greater in children and patients with hematologic malignancies
  • Common to all laparoscopic procedures: CO2 embolism, trocar site bleeding, hernia
RESULT ANALYSIS
  • In experienced hands, laparoscopic splenectomy can be performed as safely and effectively as open splenectomy, particularly for hematologic diseases in which the spleen size is normal or only slightly enlarged.
  • Operative time is longer for laparoscopic splenectomy, but the procedure offers the advantages of more rapid postoperative recovery and shorter duration of hospital stay.
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