Laparoscopic splenectomy is a surgical technique used to remove the spleen without making a large incision. You will be given general anesthesia. After you are asleep the anesthesiologist will probably insert a temporary tube into your stomach to empty it.
This will help to decompress the stomach and prevent post-operative nausea. A catheter will be inserted into your bladder to drain the urine while you are asleep. Surgery may be done with you lying flat on your back or turned onto your right side depending on surgeon preference. Several small incisions are made into the abdomen. One is used for the laparoscope which is attached to a camera that sends images to a video monitor. The other incisions are used to hold or manipulate tissue in the abdomen. Carbon dioxide gas is insufflated into the abdominal cavity to allow room to work and to allow the surgeons to see.
Parts of the spleen are freed from surrounding tissue. Blood vessels to the stomach and spleen are visualized, tied off or clipped with metal clips and divided. Once the spleen is dissected free of its attachments in the abdominal cavity, it is placed in a special surgical plastic bag and removed through one of the small abdominal incisions. If the spleen is too large to be removed in one piece, it will be broken up in the bag and removed as smaller pieces. At the end of the surgery, carbon dioxide gas is removed. The small incisions are closed with suture, the skin is cleaned and the incisions are covered with a small dressing.
Laparoscopic splenectomy is gaining increased acceptance as an alternative to open splenectomy for a wide variety of disorders, although splenomegaly still presents an obstacle to laparoscopic splenectomy; massive splenomegaly has been considered a contraindication. In patients with enlarged spleens, however, laparoscopic splenectomy is associated with less morbidity, decreased transfusion rates and shorter hospital stays than when the open approach is used. Patients with enlarged spleens usually have more severe hematologic diseases related to greater morbidity; therefore, laparoscopic splenectomy has potential advantages.
When is it necessary to remove the spleen ?
In following circumstances It is necessary to remove the spleen called as splenectomy:
- Traumatic rupture.
- Site of excessive blood cell destruction.
- Idiopathic Thrombocytopenia Purpura (ITP).
- Problem due to huge residual spleen after infection leads to splenomegaly.
- Some neoplastic disease conditions.
What are the methods of splenectomy?
There are two methods for surgical removal of spleen.
- Classical open method and
- Modern laparoscopic method.
Laparoscopic splenectomy is a safe procedure, and can provide less postoperative morbidity in experienced hands, as open splenectomy. Most cases require splenectomy can be treated laparoscopically. Laparoscopic splenectomy is a useful method for reducing hospital stay, complications and return to normal activity. With better training in minimal access surgery now available, the time has arrived for it to take its place in the surgeon’s repertoire.
Symptoms in India
- Blood disorders
- Enlarged spleen
- Benign tumors of the spleen
- Auto immune diseases of the spleen
- Splenic cysts
- Leukemia or lymphoma of the spleen
During the surgery in India
The patient will be placed under general anesthesia. A cannula (hollow tube) is placed into the abdomen by the surgeon and the abdomen will be inflated with carbon dioxide gas to create a space to operate. A laparoscope (a tiny telescope connected to a video camera) is put through one of the cannulas which project a video picture of the internal organs and spleen on a television monitor.
Several cannulas are placed in different locations on the abdomen to allow the surgeon to place instruments inside your belly to work and remove the spleen. After the spleen is cut from all that it is connected to, it is placed inside a special bag. The bag with the spleen inside is pulled up into one of the small, but largest incisions on your abdomen. The spleen is broken up into small pieces (morcelated) within the special bag and completely removed.
Laparoscopic splenectomy requires three or four small incisions ranging from 1/4 to 1/2 inch. Additionally there is a small incision usually 4-5 cm in length that is used to extract the spleen In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation. The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment.
Complications Complications following laparoscopic Splenectomy are infrequent, but you should consult your doctor regarding possible complications based on your specific case.
Possible complications may include:
- Cannula site infections,
- Internal bleeding or
- Infection inside the abdomen at the site where the spleen used to be,
- The pancreas can become inflamed (pancreatitis).