Laparoscopic partial splenectomy using a detachable clamp with and without partial splenic embolisation.
BACKGROUND
In many centres, the laparoscopic total splenectomy is a well-established routine procedure. However, the crucial immunological role of the spleen in combating bacterial infections, in particular pneumonias, has led to a search for splenic-preserving techniques whenever possible. Yet, laparoscopic partial splenectomies are still rarely described possibly due to difficulties in controlling intra-operative parenchymal bleeding during splenic transection.


METHODS
Here, we present a case series of laparoscopic partial splenectomies using a new technique. The main splenic artery and vein were temporarily clamped using a detachable clip. Transection of the spleen was possible working with the LigaSure™ instrument. After transection, the margin was sealed with a collagen fleece. In one case of a haemangioma, the patient underwent a radiological coil embolisation of the feeding arteries of the splenic pole in question. This was done 4 weeks prior to surgery and included embolisation of the tumour.


RESULTS
Three patients (2 males, 1 female, mean age 58.3 years) have been successfully treated using a detachable clamp. The pre-surgical mean size of the spleen was 8.0 × 16.7 cm (range 6 × 14-11 × 22 cm). The removed specimens had a mean size of 4.2 × 5.5 cm (range 2.5 × 4.0-5.0 × 6.5 cm). The time of surgery averaged 144 min (range 110-187 min). Blood loss was minimal thereby avoiding the need for blood transfusions. The post-surgical course was uneventful; patients were discharged 5 days following surgery. Histopathology showed a benign splenic haemangioma, a benign splenic hamartoma and the presence of Hodgkin's disease stage III.


CONCLUSIONS
The technique of laparoscopic partial splenectomy and, in certain patients, pre-surgical partial splenic embolisation is safe and effective for patients with localised diseases of the spleen. This approach combines the benefits of the minimal surgical access with saving a significant amount of splenic tissue, thereby preserving the immune function of the spleen.
Patrzyk
Maciej
M
Department of General, Visceral, Thoracic and Vascular Surgery, Universitätsklinikum, Ernst-Moritz-Arndt-University, Friedrich-Loeffler-Strasse 23b, Greifswald, Germany. patrzyk@uni-greifswald.de
Glitsch
Anne
A
Hoene
Andreas
A
von Bernstorff
Wolfram
W
Heidecke
Claus Dieter
CD
D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012494:Sampling Studies; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D013158:Splenic Diseases / Q000473:pathology / Q000601:surgery*; D013525:Surgical Instruments; D016896:Treatment Outcome