Laparoscopic Splenectomy

Spleen Removal

Spleen:

The spleen is an organ located in the upper left portion of the abdomen behind the stomach. Its functions are to filter blood, remove bacteria, make blood, and store blood.

Indications for Splenectomy:

The most common conditions that warrant splenectomy in an adult are listed below:

Hereditary spherocytosis – a blood disorder characterized by numerous abnormally (sphere) shaped red blood cells.

Idiopathic thrombocytopenia purpura (ITP) – a blood disorder that involves bruising and frequently spontaneous bleeding due to an poor function and decreased number of platelets.

Thalassemia – a combination of genetic blood disorders resulting in the underproduction of hemoglobin (element of the blood that carries oxygen).

Staging for Hodgkin’s Lymphoma (cancer originating in the lymph node)- surgeons will sometimes remove the spleen to determine the extent of involvement and plan of treatment. This is less commonly performed today secondary to improved diagnostics and chemotherapy.

Splenomegaly (enlargement of the spleen) is a common result of genetic disorders of the blood. If the spleen measures over 800 grams, the laparoscopic approach may be inadvisable.

Less common indications for splenectomy include:

• Splenic abscess
• Splenic mass
• Cysts
• Splenic vein thrombosis or obstruction
• Sickle Cell
• Surgery involving the pancreas or stomach
• Primary splenic neutropenia
• Felty’s syndrome
• Banti’s disease

Before Surgery:

Extensive series of blood tests and a CT scan to establish your diagnosis will be performed prior to surgical consideration. Children, undergoing splenectomy before the age of 5 years, should be treated with a daily dose of penicillin until the age of 10 years. All patients who undergo splenectomy should be immunized with Pneumovax preferably two or more weeks before the operation. Children less than 10 years old and immunosuppressed patients should also be vaccinated against pneumococcus, H. influenza, meningococcus, and Hepatitis B.

Surgery:

Laparoscopic spleen removal involves specialized video equipment and instruments that allow a surgeon to remove the spleen through several tiny incisions. Open surgery involves a large midline incision. The operation is performed from a flank approach using four small incisions. After routine exploration the splenic vessels are isolated and divided. The spleen is freed, placed into a sac, fragmented, and removed in small pieces through the 1-2 cm incision.

Recovery:

Patients recover sooner after laparoscopic splenectomy. Return to activities can occur within 3-7 days compared to 4-6 weeks with an open approach. Pain experienced by the open technique is greater and longer lasting. 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.

Pertinent References

Demeure M, and Frantzides CT: Early experience with laparoscopic splenectomy. Wisc Med. J. 97(10)33-36, 1998.

Chi A, Zografakis G, Demeure M, “Minimally Invasive Splenectomy” in Frantzides, CT, Carlson M, eds. Atlas of Minimally Invasive Surgery Philadelphia Sunders Elsevier 2008.