| What is Splenectomy? Splenectomy means surgical | | | | operating room. The anesthesiologist and nurses will |
| removal of spleen. The spleen is a blood filled organ | | | | use monitors to check your heart rate and breathing |
| located in the upper left abdominal cavity. It is a | | | | during the procedure. These may include EKG leads, a |
| storage organ for red blood cells and contains many | | | | blood pressure cuff, an oxygen mask and sleeves on |
| specialized white blood cells called "macrophages" | | | | your legs to prevent clots from forming. |
| (disease fighting cells) which act to filter blood. The | | | | During the surgery |
| spleen is part of the immune system and also | | | | The patient will be placed under general anesthesia. A |
| removes old and damaged blood particles from your | | | | cannula (hollow tube) is placed into the abdomen by |
| system. The spleen helps the body identify and kill | | | | the surgeon and the abdomen will be inflated with |
| bacteria. | | | | carbon dioxide gas to create a space to operate. A |
| What are the Indications for Splenectomy? | | | | laparoscope (a tiny telescope connected to a video |
| There are several reasons why a spleen might need | | | | camera) is put through one of the cannulas which |
| to be removed, and the following list, though not all | | | | project a video picture of the internal organs and |
| inclusive, includes the most common reasons. The | | | | spleen on a television monitor. Several cannulas are |
| most common conditions that warrant Splenectomy in | | | | placed in different locations on the abdomen to allow |
| an adult are: | | | | the surgeon to place instruments inside your belly to |
| * Trauma to the organ | | | | work and remove the spleen. After the spleen is cut |
| * Blood disorders like Hemolytic anemia (a condition | | | | from all that it is connected to, it is placed inside a |
| that breaks down red blood cells) | | | | special bag. The bag with the spleen inside is pulled up |
| * Enlarged spleen | | | | into one of the small, but largest incisions on your |
| * Benign tumors of the spleen | | | | abdomen. The spleen is broken up into small pieces |
| * Auto immune diseases of the spleen | | | | (morcelated) within the special bag and completely |
| * Spleenic cysts | | | | removed. Laparoscopic splenectomy requires three or |
| * Selected leukemias or lymphomas that affect the | | | | four small incisions ranging from 1/4 to 1/2 inch. |
| spleen | | | | Additionally there is a small incision usually 4-5 cm in |
| * Genetic conditions that affect shape of RBC, like | | | | length that is used to extract the spleen |
| hereditary spherocytosis in which there are abnormally | | | | In a small number of patients the laparoscopic method |
| sphere shaped red blood cells or Thalassemia major | | | | cannot be performed. Factors that may increase the |
| How are these problems diagnosed? | | | | possibility of choosing or converting to the "open" |
| An evaluation typically includes a complete blood count | | | | procedure may include obesity, a history of prior |
| (CBC), a visual look at the blood cells placed on a | | | | abdominal surgery causing dense scar tissue, inability to |
| glass slide called a 'smear', and often a bone marrow | | | | visualize organs or bleeding problems during the |
| examination. Sometimes an ultrasound examination of | | | | operation. The decision to perform the open procedure |
| your spleen, a computerized tomography (CT scan), | | | | is a judgment decision made by your surgeon either |
| magnetic resonance imaging (MRI) or nuclear scan is | | | | before or during the actual operation. When the |
| needed. | | | | surgeon feels that it is safest to convert the |
| How is it done? | | | | laparoscopic procedure to an open one, this is not a |
| There are two ways to perform Splenectomy: open | | | | complication, but rather sound surgical judgment. |
| or laparoscopic. But not all patients are candidate for | | | | During the surgery |
| open method. Certain conditions like in cases of trauma | | | | The patient will be placed under general anesthesia. A |
| where intra-abdominal bleeding interferes with the | | | | cannula (hollow tube) is placed into the abdomen by |
| surgeon's ability to visualize the blood vessels, requires | | | | the surgeon and the abdomen will be inflated with |
| open surgery. Spleens which are massively enlarged | | | | carbon dioxide gas to create a space to operate. A |
| may also pose a problem for the surgeon because | | | | laparoscope (a tiny telescope connected to a video |
| the size of the spleen restricts the visualization and | | | | camera) is put through one of the cannulas which |
| manipulation of the spleen. | | | | project a video picture of the internal organs and |
| Sometimes the surgeon may decide to convert the | | | | spleen on a television monitor. Several cannulas are |
| laparoscopic surgery to an open procedure in certain | | | | placed in different locations on the abdomen to allow |
| situations and for patient safety. Though very | | | | the surgeon to place instruments inside your belly to |
| infrequent, when conversion to an open technique | | | | work and remove the spleen. After the spleen is cut |
| occurs, it should not be considered a failure of the | | | | from all that it is connected to, it is placed inside a |
| procedure. In other situations, one of the small incisions | | | | special bag. The bag with the spleen inside is pulled up |
| may be enlarged some for better handling of the | | | | into one of the small, but largest incisions on your |
| spleen. This is called 'laparoscopically assisted' or 'hand | | | | abdomen. The spleen is broken up into small pieces |
| assisted laparoscopic splenectomy' and is particularly | | | | (morcelated) within the special bag and completely |
| helpful in the very large spleens. | | | | removed. Laparoscopic splenectomy requires three or |
| Conventional method or open method | | | | four small incisions ranging from 1/4 to 1/2 inch. |
| Traditionally, removal of the spleen has been | | | | Additionally there is a small incision usually 4-5 cm in |
| accomplished using one larger incision. Since the cut is | | | | length that is used to extract the spleen |
| big, it takes more time to heal compared to | | | | Benefits and drawbacks |
| laparoscopic incision. Open Splenectomy would require | | | | Results may vary depending on your overall condition |
| hospitalization for 3-7 days and 2-6 weeks for a full | | | | and health. Usually laparoscopic method has added |
| recovery. | | | | benefits. They are: |
| Laparoscopic method | | | | * Less postoperative pain |
| Laparoscopic or minimally invasive approach involves | | | | * Shorter hospital stay |
| specialized video equipment and instruments that allow | | | | * Faster return to a regular, solid food diet |
| a surgeon to remove the spleen through several tiny | | | | * Quicker return to normal activities |
| incisions, versus a traditional large midline incision for an | | | | * Better cosmetic results |
| open approach. | | | | Complications |
| Before the surgery | | | | Complications following laparoscopic Splenectomy are |
| After your surgeon reviews with you the potential | | | | infrequent, but you should consult your doctor regarding |
| risks and benefits of the operation, you will need to | | | | possible complications based on your specific case. |
| provide written consent for surgery. Your surgeon | | | | Possible complications may include: |
| may request that you completely empty your colon | | | | * Cannula site infections, |
| and cleanse your intestines prior to surgery. You may | | | | * Pneumonia, |
| be requested to drink clear liquids, only, for one or | | | | * Internal bleeding or |
| several days prior to surgery. | | | | * Infection inside the abdomen at the site where the |
| The laparoscopic Splenectomy is usually performed | | | | spleen used to be, |
| with general anesthesia. An IV line will be placed in | | | | * The pancreas can become inflamed (pancreatitis). |
| your arm for fluids and you will be brought into the | | | | |