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Case Reports
. 2020;77S(Suppl):S44-S47.
doi: 10.1016/j.ijscr.2020.10.022. Epub 2020 Oct 14.

Laparoscopic near-total splenectomy. Report of a case

Giuseppe Di Buono  1 , Elisa Maienza  2 , Salvatore Buscemi  3 , Leonardo Gulotta  4 , Giorgio Romano  5 , Antonino Agrusa  6
Affiliations
Case Reports

Laparoscopic near-total splenectomy. Report of a case

Giuseppe Di Buono et al. Int J Surg Case Rep. 2020.

Abstract

Introduction: Splenectomy is a surgical procedure indicated for the treatment of most benign and malignant splenic diseases, especially hematologic disorders. Laparoscopic approach is preferable to the open surgery for most indications because it reduces intra- and post-operative complications and shortens hospital stay. Laparoscopic approach is also feasible for partial splenectomy. Spleen-preserving techniques reduce the risk of severe infections and thromboembolic events that can occur after total splenectomy CASE PRESENTATION: We report a case of a 50-year old woman with an incidentally discovered voluminous lesion in the superior pole of spleen. A laparoscopic near-total splenectomy was performed.

Discussion: The evidence about the potential complications in splenectomised patients speaks in favour of performing spleen-sparing surgical techniques whenever possible. Most common indications for laparoscopic partial splenectomy are non-parasitic splenic cystic, benign splenic tumors, splenic haematological diseases, non-cystic intraparenchymal lesions, spleen rupture, splenic abscess, vascular abnormalities. Laparoscopic near total splenectomy is an innovative partial splenectomy technique consisting on preserving a residual spleen volume.

Conclusion: LNTS seems to be a safe and effective technique for the management of benign spleen diseases. The comparison between other spleen preserving techniques shows that LNTS is associated with a lower rate of secondary surgery and postoperative recurrence of anaemia.

Keywords: Laparoscopic splenectomy; Laparoscopic surgery; Near-total splenectomy; Splenectomy.

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Figures

Fig. 1
Fig. 1
Details of surgical procedure: a) laparoscopic exploration with identification of voluminous lesion in the upper pole of the spleen; b) clipped splenic artery (arrow) and splenic vein (dashed arrow); c–d) ischemic parenchyma demarcation zone treated with monopolar hook.
Fig. 2
Fig. 2
Details of surgical procedure: a–b) dissection of splenic parenchyma with Harmonic device; c–d) use of warm saline solution in order to improve coagulation and reduce the fog of operating field.
Fig. 3
Fig. 3
a) the results at the end of surgical procedure; b–c–d) use of the haemostatic matrix (Floseal®) above the residual spleen that was put into its natural cavity using fibrin sealant.
See this image and copyright information in PMC

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