Laparoscopic splenectomy: clinical experience and the role of preoperative splenic artery embolization.
We describe the clinical course of 12 patients who underwent laparoscopic splenectomy. Two patients were converted to open surgery--the first patient in the series because of a hemorrhagic incident and the eighth, who had a 34-cm spleen, because of dissection difficulties. The remaining patients had no mortality, and perioperative morbidity was 10%. After an average postoperative stay of 3.5 days (range, 2-9), most patients were able to resume normal activities < or = 2 weeks. Use of preoperative splenic artery embolization was begun with the third patient. The technique involved embolization of the spleen with coils placed proximally; and contour emboli, absorbable gelatin sponge, and small coils placed distally, taking care to spare vessels to the tail of the pancreas. A good linear correlation was established between operative blood loss and the percentage of splenic devascularization by preoperative splenic artery embolization (r - 0.8084). Laparoscopic splenectomy is becoming the preferred technique for elective removal of a normal sized or moderately enlarged spleen (< 20 cm long) when hematologic indications are present.
Poulin
E
E
Department of Surgery, Hôpital du Saint-Sacrement, Québec, Canada.
Thibault
C
C
Mamazza
J
J
Girotti
M
M
Côté
G
G
Renaud
A
A
D000293:Adolescent; D000328:Adult; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D013156:Splenectomy / Q000379:methods*; D013157:Splenic Artery