Early Ligation of the Splenic Artery in the Leaning Spleen Approach to Laparoscopic Splenectomy
| Autor: | Rangasamy Senthilkumar, Kalpesh Jani, R. Shetty, G. S. Maheshkumar, Vijaykumar Malladi, C. Palanivelu |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Spleen Spherocytosis Hereditary Splenic artery Lesser sac Catheters Indwelling Echinococcosis medicine.artery medicine Splenocolic ligament Humans Ultrasonography Doppler Color Ligation Splenic flexure Purpura Thrombocytopenic Idiopathic business.industry Cholecystolithiasis Graft Occlusion Vascular Length of Stay Surgery Treatment Outcome medicine.anatomical_structure Cholecystectomy Laparoscopic Splenic Vein Splenomegaly Splenectomy Ligament Laparoscopy Cholecystectomy Anemia Hemolytic Autoimmune business Splenic Artery Colon Transverse Follow-Up Studies |
| Zdroj: | Journal of Laparoendoscopic & Advanced Surgical Techniques. 16:339-344 |
| ISSN: | 1557-9034 1092-6429 |
| DOI: | 10.1089/lap.2006.16.339 |
| Popis: | A variety of approaches have been proposed for laparoscopic splenectomy, including the anterior approach, the lateral approach (hanging spleen technique), and the semilateral approach (leaning spleen technique). We advocate a leaning spleen approach with early ligation of the splenic artery.Since 1997, we have performed 120 laparoscopic splenectomies using the leaning spleen approach along with early ligation of the splenic artery. The patient is placed in a 70-degree semi-right lateral position. The operative steps are: exposure of the lesser sac, control of the splenic artery, mobilization of the splenic flexure, division of the splenocolic ligament, division of the splenophrenic ligament, hilar mobilization, mobilization of the upper pole of the spleen, and removal of the specimen.The most common indication for surgery was autoimmune hemolytic anemia (35.8%). One patient had severe perisplenitis with extensively vascularized adhesions, which led to oozing during surgery obscuring the laparoscopic view, requiring conversion to open surgery. The mean spleen diameter was 22.8 cm (range, 12.5-37.0 cm) on imaging. The mean operative time was 85 minutes (range, 54-124 minutes). Concomitant laparoscopic cholecystectomy for pigment stone cholelithiasis was performed in 8.3% of the patients. Accessory splenic tissue was found in 4.2%. The average hospital stay was 3 days (range, 1-6 days). There were no significant postoperative complications. The average follow-up has been 5.4 years (range, 1 month-9 years).In adopting the modification of early ligation of the splenic artery in the leaning spleen approach, we believe we have helped to advance laparoscopic splenectomy. |
| Databáze: | OpenAIRE |
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