Anatomy and techniques in segmental splenectomy.

Abstract

Accumulating clinical experience indicates the desirability of retention of splenic tissue and function. Results of angiographic studies in human and canine spleens demonstrate that intrasplenic vessels are lobar, segmental and, generally, without intersegmental communication. In the dog, bleeding from peripheral region vessels--penicilli, venules and sinuses--is well controlled by either microfibrillar collagen or the neodymium yttrium aluminum garnet laser. However, larger segmental vessels in the intermediate or hilar regions cannot be controlled by microfibrillar collagen or the neodymium yttrium aluminum garnet laser and require ligation. Identification of these vessels is greatly facilitated by laser or microfibrillar collagen coagulation of the surrounding splenic tissue. Results of histologic studies at ten, 20 and 30 day healing intervals disclosed no delayed sloughs, hemorrhage or cyst formation. With knowledge of segmental vascular anatomy and the techniques of microfibrillar collagen, neodymium yttrium aluminum garnet laser incision and coagulation plus aspiration and vessel ligation, segmental or subtotal splenic resection can be readily accomplished in dogs with minimal blood loss.