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Laparoscopic partial splenectomy: a technical tip

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Abstract

Background

Increased awareness of asplenia-related life-threatening complications has led to development of parenchyma sparing splenic resections. The aim of the study was to report a new technique of laparoscopic partial splenectomy, which helps minimize perioperative bleeding risks.

Methods

From November 2004 to October 2012, 12 patients underwent partial laparoscopic resection of the spleen. There were six men (50 %), and median age was 30 years (19–62). Transection of the splenic parenchyma was performed along a line situated 1 cm within the ischemic demarcation, which appeared after ligation of the sectorial vascular pedicles feeding the tumor. Antibiotic prophylaxis and preventive antibacterial immunization were prescribed systematically according to generally accepted guidelines.

Results

Mortality was nil, and operative complications occurred in 2 (17 %) patients. Conversion to open partial splenectomy and to laparoscopic total splenectomy was performed in one patient (8.3 %) each. Median operative time was 120 min (range 80–180 min). Median blood loss was 90 ml (range 10–450 ml), and transfusion was not required. Median tumor size was 7 cm (4–12 cm). The median in hospital stay was 5 days (4–7 days). Patients did not comply with long-term (>2 years) immunization and antibioprophylaxis rules. After a median follow-up of 5 years (18 months–9 years), no case of overwhelming post-splenectomy infections occurred.

Conclusion

Laparoscopic partial splenectomy can be safely performed in patients with splenic tumors. Parenchyma transection 1 cm inside the ischemic demarcation line is a key technical point to minimize blood loss.

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Disclosures

Drs. Bruno de la Villeon, Alban Lebihan, Helene Vuarnesson, Nicolas Munoz Bongrand, Bruno Halimi, Emile Sarfati, Pierre Cattan, and Mircea Chirica have no conflict of interests or financial ties to disclose

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Authors and Affiliations

  1. Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, APHP, Université Paris 7 Diderot, Paris, France

    Bruno de la Villeon, Alban Zarzavadjian Le Bian, Helene Vuarnesson, Nicolas Munoz Bongrand, Bruno Halimi, Emile Sarfati, Pierre Cattan & Mircea Chirica

  2. Centre Hospitalier Universitaire Saint-Louis, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France

    Mircea Chirica

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  1. Bruno de la Villeon
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  2. Alban Zarzavadjian Le Bian
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Correspondence to Mircea Chirica.

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de la Villeon, B., Zarzavadjian Le Bian, A., Vuarnesson, H. et al. Laparoscopic partial splenectomy: a technical tip. Surg Endosc 29, 94–99 (2015). https://doi.org/10.1007/s00464-014-3638-z

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  • DOI: https://doi.org/10.1007/s00464-014-3638-z

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