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PubMed2004

Laparoscopic splenectomy for haematological diseases.

PURPOSE: To show the utility of laparoscopic splenectomy for hematologic diseases. PATIENTS AND METHODS: Ten patients with hematologic diseases who were operated between February 1997 and October 1998 were analysed retrospectively. TECHNIQUE: The operations were performed by four trocars, hilar vessels were divided by clips and bag was used for splenic retrival. RESULTS: All operations were completed successfully. No accessory spleens were found. Intraoperative complication, other than a bag tear in one operation did not occur. Postoperative complications occurred in two patients. The first one was a portal vein thrombosis and the second one was a peritonitis. All patients responded hematologically to the operation. CONCLUSION: With appropriate surgical technique and patient follow up, laparoscopic splenectomy is a safe, adventageous and efficaceus operation for hematologic diseases.

Adult↗
PubMed2003

The effect of dosage, gestational age and splenectomy on anti-IgM interception of prenatal B-cell development in sheep.

The administration of a single bolus of anti-IgM antibody to foetal lambs early in pregnancy produces prolonged B-cell depletion. The present study investigated this depletion by examining the effect, on B-cell development in the ileal Peyer's patches, of varying the timing and dosage of antibody administration and by supplementing anti-IgM with surgical splenectomy. The capacity of a 1 mg bolus of anti-IgM to deplete Peyer's patches of B cells was lost if its administration was deferred until two thirds of the way through pregnancy, but persisted beyond this time if weight-adjusted doses were used. Splenectomy of the foetus performed at an earlier age failed to extend the age at which a 1 mg dose of antibody remained effective. As the concentration of murine immunoglobulin in foetal serum was greatly reduced after 21 days, it is inferred that ongoing suppression of B-cell development is not dependent on the continued presence of murine immunoglobulin. The enduring nature of suppression could be attributable to a limited period during which differentiation of B cells from stem cells normally occurs, although further studies will be needed to investigate this and other possible explanations for the effect of anti-IgM treatment on prenatal B-cell development in sheep.

Animals↗
PubMed2002

Computer-assisted laparoscopic splenectomy with the da Vinci surgical robot.

Laparoscopic splenectomy has become the standard of care for the surgical treatment of idiopathic thrombocytopenic purpura (ITP). The minimally invasive approach to splenic disorders such as ITP clearly results in the same benefits to the patients as have been demonstrated with the laparoscopic cholecystectomy techniques. New technologies in minimally invasive surgery have resulted in the development of robotic devises that assist the surgeon during the procedures. Robotic surgery is in its infancy at this point in time. Herein, we report a splenectomy performed with the assistance of the da Vinci surgical robot. With advancement of technology, robotic systems will play an integral role in future minimally invasive surgery.

Aged↗
PubMed2003

Grasper-assisted versus traditional laparoscopic splenectomy in the management of hematologic disorders.

OBJECTIVE: To compare the technical benefits of grasper-assisted laparoscopic splenectomy (LS) with traditional LS. METHODS: The study comprised 27 consecutive patients who were admitted to our hospital from 1998 to 2002 and underwent LS: 13 patients underwent traditional LS (group 1), and 14 had grasper-assisted LS (group 2). RESULTS: In both groups, the most common indication for LS was idiopathic thrombocytopenic purpura. There was no difference between the groups in the demographic characteristics of patients. All splenectomies were performed in the right semidecubitus position, using four or five trocars. Conversion to open surgery was required in one patient (7.7%) in group 1 and in one patient (7.1%) in group 2. Both conversions occurred during the initial 16 operations and no conversion occurred during the subsequent 11 operations. The mean operating time was significantly shorter for group 2 (132 minutes) than for group 1 (154 minutes) (P <.005). Mean estimated blood loss (201 vs. 282 mL) was also lower in group 2 than in group 1 (P <.05). The mean length of hospital stay was 3.3 days in group 1 and 2.4 days in group 2 (P >.05). CONCLUSION: Grasper-assisted LS is both safe and feasible in patients with hematologic diseases. This technique can be preferred in order to grasp and position the spleen during the surgery.

Adult↗
PubMed1999

Laparoscopic splenectomy at caesarean section.

The role of minimally invasive surgery continues to expand in all the specialties and subspecialties of surgery. At one time, obesity and pregnancy were considered a relative contraindication to laparoscopic surgery. With improved technology and skills, surgeons are able to operate on patients who were once considered to be at too high a risk for laparoscopic surgery. Herein, laparoscopic splenectomy performed at the time of Caesarean section is reported. This case demonstrates the safety and efficacy of laparoscopic splenectomy in a morbidly obese female in the immediate postpartum time.

Adult↗
PubMed2005

Laparoscopic splenectomy for hematologic disorders: experience with the first fifty patients.

BACKGROUND: Splenectomy is increasingly being performed by various minimal access surgical modalities for select hematologic disorders. METHODS: A retrospective analysis was performed on the first 50 patients on whom laparoscopic splenectomy (LS) was attempted. The data studied included indications for surgery, patient demographics, intraoperative parameters, and patient outcomes. A total laparoscopic approach (TLS) was employed in 38 patients and a hand-assisted technique (HALS) was used in 12 patients with massive splenomegaly. Eight patients had concomitant surgical procedures: 7 patients underwent laparoscopic cholecystectomy and 1 patient received a kidney transplant. The most common indications for LS were idiopathic thrombocytopenic purpura (ITP) (50%) and hereditary spherocytosis (24%). RESULTS: LS was successfully completed in 48 patients (96%). Thirty-four patients (68%) required perioperative blood or platelet transfusions. The mean spleen diameter was 17.1 cm (range, 11.2-28.4 cm) on imaging study and mean intact splenic weight was 1019 gm. The mean operative time was 188 minutes (range, 90-340 minutes) in the TLS group and 171 minutes (range, 120-240 minutes) in the HALS group. The mean intraoperative blood loss was 306 mL (range, 40-640 mL) in the TLS group and 163 mL (range, 100-300 mL) in the HALS group. The mean postoperative hospital stay was 3.2 days (range, 2-5 days). CONCLUSION: TLS is safe and feasible in patients with nonpalpable spleens. A concomitant laparoscopic procedure for treating coexisting abdominal pathology may be performed without additional morbidity. The HALS technique may be preferable in patients with splenomegaly (palpable spleens), as it appears to offer intraoperative advantages for retraction, dissection, hemostasis, and organ retrieval.

Blood Loss, Surgical↗
PubMed2005

Laparoscopic splenectomy for metastatic squamous cell cancer of the neck.

Squamous cell carcinoma (SCC) spreads through direct extension, lymphatic vessels, and, rarely, hematogenous routes. The most common malignancies to metastasize to the spleen include carcinomas of the breast, lung, and melanoma. We present an unusual case of SCC of the neck with splenic metastases. The patient presented with a primary solid tumor of the neck that extended into the surrounding soft tissues, including the internal jugular vein and regional lymph nodes. A metastatic work-up with a positron emission tomograph showed enhancement in the left upper quadrant. A computed tomograph (CT) was then performed. The CT revealed three distinct splenic lesions, the largest measuring 6x6.5x2.5 cm. Subsequently, the patient was scheduled for a splenectomy. At the time of operation, diagnostic laparoscopy revealed only the splenic lesions. A laparoscopic splenectomy was performed successfully and the patient was started on a regular diet on postoperative day 1. This paper describes the first documented case of SCC of the neck with splenic metastases. The lesion was diagnosed and treated laparoscopically. The case is described in detail along with the clinical implications of this rare finding.

Carcinoma, Squamous Cell↗
PubMed1980

Polycythemia vera with myelofibrosis and myeloid metaplasia. Acute hepatic failure following splenectomy.

Myelofibrosis with myeloid metaplasia developed during the course of polycythemia vera in a middle-aged man. Severe megakaryocytopenia and thrombocytopenia were early features of this illness and were unresponsive to splenectomy. After splenectomy, hepatic enlargement and acute hepatic failure developed. Extensive extramedullary hematopoiesis dilating hepatic sinusoids and compressing liver cells was the major pathologic finding in the liver. The mechanism of hepatic failure in this disorder is uncertain.

Adult↗
PubMed2002

Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma: Japan clinical oncology group study JCOG 0110-MF.

A randomized controlled trial has started in Japan to evaluate the role of splenectomy in the surgical management of gastric cancer. Patients with T2 or deeper carcinoma in the proximal third of the stomach are intra-operatively randomized to either splenectomy or spleen preservation. Tumors invading the greater curvature of the stomach or those with apparent nodal involvement in the splenic hilum are excluded. Surgeons in 29 specialized institutions will recruit 500 patients. Endpoints are overall survival, operative morbidity, operative time and blood loss.

Adenocarcinoma↗
PubMedDate not supplied

Overwhelming pneumococcal sepsis 25 years after splenectomy.

In a 47-year-old healthy male, the syndrome of overwhelming pneumococcal sepsis, associated with diffuse intravascular clotting, appeared 25 years after a post-traumatic splenectomy. Although no other disease was present, the course was fulminant and the outcome fatal. Splenectomy for any condition and in all ages, augments the risk to severe pneumococcal infection.

Humans↗
PubMedDate not supplied

Case report: splenectomy in patients with Hodgkin's disease and marrow hypoplasia.

Two patients with Hodgkin's disease and hypoplastic bone marrow underwent splenectomy in an attempt to reverse pancytopenia and to improve chemotherapeutic tolerance. Although the peripheral blood counts were improved, the clinical course was not significantly affected. Infectious complications occurred. This suggests that the peripheral hematologic improvement following splenectomy may not reflect a true improvement in marrow tolerance.

Adult↗
PubMed1984

Selective variceal decompression after splenectomy or splenic vein thrombosis. With a note on splenopancreatic disconnection.

Eight patients have had selective variceal decompression after a splenectomy or splenic vein thrombosis with successful control of bleeding. The principle veins utilized in these patients, either alone or in combination, were: (a) the splenic remnant, (b) the coronary, (c) the gastroepiploic, and (d) an inferior mesenteric that joined the splenic. High quality preoperative angiography is essential but operative exploration is often required to assess fully the possible shunt options. Simple splenectomy for thrombocytopenia in portal hypertension is rarely justifiable and creates far more problems than it solves. Complete splenopancreatic disconnection extends the selective shunt concept.

Adolescent↗
PubMed1990

Elective subtotal splenectomy. Indications and results in 33 patients.

Elective subtotal splenectomy was performed in 33 patients (30 children and 3 adults) between 1981 and 1989. Indications for the procedure were (1) prevention of azathioprine-induced neutropenia (n = 20); (2) Type I Gaucher disease (n = 9); and (3) cholesteryl ester storage disease, chronic myelogenous leukemia, thalassemia major, and splenic cyst in one patient each. There were no operative deaths, no reoperations for bleeding, and 30 of 33 (91%) patients had a functioning splenic remnant documented by a postoperative radionuclide spleen scan. One patient developed neutropenia without evidence of viral infection that required temporary cessation of azathioprine and the patient with thalassemia major had only transient improvement in transfusion requirements. All other patients (94%) had control of the underlying condition for which the operation was performed. We conclude that subtotal splenectomy is a safe, effective therapy for a variety of nontraumatic conditions.

Adolescent↗
PubMed1998

Splenomegaly should not be considered a contraindication for laparoscopic splenectomy.

OBJECTIVE: To analyze the impact of spleen size on operative and immediate clinical outcome in a series of 74 laparoscopic splenectomies (LS). SUMMARY BACKGROUND DATA: LS is gaining acceptance as an alternative to open splenectomy. However, splenomegaly hinders LS, and massive splenomegaly has been considered a contraindication. METHODS: Between February 1993 and September 1997, 74 patients with a wide range of splenic disorders were treated by laparoscopy and prospectively recorded. They were classified into three groups according to spleen weight: group I, <400 g (n = 52); group II, 400 to 1000 g (n = 9); and group III, >1000 g (n = 13). Age, operative time, number of trocars required, need for perioperative transfusion, spleen weight, conversion rate, mode of spleen retrieval (bag or accessory incision), postoperative analgesia requirements, length of hospital stay, and morbidity rates were recorded. RESULTS: LS was completed in 69 patients, and the conversion rate was thus 6.7%. Operative time was significantly longer in patients with larger spleens, and an accessory incision was more frequently required. However, there were no significant differences in transfusion rate, length of stay, severe morbidity, or conversion rate. CONCLUSIONS: Preliminary evaluation of LS for patients with large spleens suggests that it requires a longer operative time, but it is feasible and may potentially offer the same advantages (shorter stay and faster recovery) as it does to those with smaller spleens.

Adolescent↗
PubMed1998

Laparoscopic splenectomy: outcome and efficacy in 103 consecutive patients.

OBJECTIVE: To study the safety and efficacy of laparoscopic splenectomy (LS) in patients with predominantly benign hematologic disorders. SUMMARY BACKGROUND DATA: The technical feasibility of LS has been recently established. However, data regarding the efficacy of the procedure in a large cohort of patients are scarce. METHODS: One hundred three consecutive patients underwent LS between June 1992 and October 1997. Data were collected prospectively on all patients. RESULTS: Indications were idiopathic thrombocytopenic purpura (ITP), hereditary spherocytosis, autoimmune hemolytic anemia, thrombotic thrombocytopenic purpura, and others. Mean spleen size was 14 cm and mean weight was 263 g. Accessory spleens were found in 12 patients with ITP and in 5 patients without ITP. There were no deaths. Complications occurred in six patients, one requiring a second procedure for small bowel obstruction. Six patients received transfusions, and four procedures were converted to open splenectomy for bleeding. Mean surgical time was 161 minutes and was greater in the first 10 cases than the last 10. Mean postsurgical stay was 2.5 days. Thrombocytopenia resolved after surgery in 84% of patients with ITP, and hematocrit levels increased significantly in 70% of patients with chronic hemolytic anemias. A positive response was noted in 92% of patients with hereditary spherocytosis, without relapse for the duration of the observation. ITP relapsed in four patients during follow-up, three within 12 months. CONCLUSIONS: LS can be performed safely and effectively in a teaching institution. Rigorous technique will minimize capsular fractures, reducing the risk of splenosis. Accessory spleens can be successfully localized, thus improving response and limiting recurrence of ITP. LS should become the technique of choice for treatment of intractable benign hematologic disease.

Adult↗
PubMed1981

Post-splenectomy demonstration of splenic tissue by computed tomography with liposoluble contrast material.

The significance of localizing accessory spleens in patients with hematologic disorders as well as demonstrating splenic regeneration following splenectomy is well recognized. An experimental contrast material has been developed that, after intravenous injection, selectively opacifies the liver and spleen on computed tomograms. The contrast material was primarily developed to detect small avascular liver lesions (metastases). Its value in detecting accessory or recurrent spleen was recognized incidentally when a patient with testicular carcinoma and a previous splenectomy showed opacification of splenic tissue in the left upper abdomen.

Adult↗
PubMed1996

Granulocyte-macrophage colony-stimulating factor (GM-CSF) enhances pulmonary defenses against pneumococcal infections after splenectomy.

BACKGROUND: Splenectomized individuals are at risk for pneumococcal sepsis. Alveolar macrophage bactericidal function is depressed after splenectomy. Granulocyte-macrophage colony-stimulating factor (GM-CSF) has pronounced effects on the number and function of macrophages. We hypothesized that GM-CSF treatment could improve alveolar macrophage bactericidal activity against pneumococci, and improve survival with pneumococcal infection. METHODS: Two weeks after splenectomy or sham operation, mice were treated with GM-CSF or saline twice daily for varying times. Alveolar macrophages were obtained by bronchopulmonary lavage, and bactericidal activity was measured. Survival was assessed after pneumococcal aerosol challenge. RESULTS: Alveolar macrophage bactericidal activity was improved with GM-CSF treatment in both eusplenic and asplenic mice (p < 0.001). GM-CSF treatment improved survival in both groups (p < 0.001). CONCLUSIONS: GM-CSF can augment alveolar macrophage function and provide protection against pneumococcal infections. It may be a useful adjuvant therapy for normal and splenectomized individuals.

Animals↗