Hand-assisted laparoscopic splenectomy for idiopathic thrombocytopenic purpura during pregnancy.
A successful case of a hand-assisted laparoscopic splenectomy with low-pressure pneumoperitoneum for autoimmune thrombocytopenic purpura in a patient at 23 weeks' gestation is reported. Preoperative splenic arterial embolization was performed on the same day as the operation using painless contour embolic material and super-absorbent polymer microspheres. The abdominal wall retraction method first was applied to avoid the effects of pneumoperitoneum on systemic hemodynamic alterations. However, a sufficient surgical view could not be obtained, as the intra-abdominal organs were elevated because of the enlarged uterus. A surgical view with 4 to 6-mm Hg pneumoperitoneum was available for the hand-assisted splenectomy. The postoperative course was uneventful, and the patient vaginally delivered a healthy infant. A hand-assisted laparoscopic splenectomy with low-pressure pneumoperitoneum after splenic arterial embolization would be feasible for patients with autoimmune thrombocytopenic purpura during a relatively advanced pregnancy.
Iwase
K
K
Department of Surgery, Rinku General Medical Center, Izumisano Municipal Hospital, Osaka, Japan.
Higaki
J
J
Yoon
H E
HE
Mikata
S
S
Tanaka
Y
Y
Takahashi
T
T
Hatanaka
K
K
Tamaki
T
T
Hori
S
S
Mitsuda
N
N
Kamiike
W
W
D000328:Adult; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000601:surgery*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D013157:Splenic Artery