Anatomical Basis and Clinical Application of Laparoscopic Splenectomy / 中国微创外科杂志

ABSTRACT

Objective To investigate the laparoscopic anatomy of the spleen vessels and its clinical application. Methods The data of 47 cases of total laparoscopic splenectomy (TLS) were analyzed. Among the patients, 21 had cirrhotic portal hypertension, 19 had thalassemia, 2 idiopathic thrombocytopenic purpura, 2 hereditary spherocytosis, 1 angioma of the spleen, 1 splenic cyst, and 1 primary hypersplenism. The color of the spleen was observed after the splenic artery near the pancreatic tail was ligated. And then the splenic artery was categorized according to the color. Results Among the 47 cases, 34 (72.3%) were categorized as typeⅠ, 9 were type Ⅱ (19.1%), and 2 were type Ⅲ (4.3%). The arterial anatomy was unclear under a laparoscope in 2 cases (4.3%). The TLS was completed in 46 cases with a success rate of 97.9% (46/47). Among the cases, 14 received extensive esophagogastric devascularization simultaneously,and 3 patients who had thalassemia underwent cholecystecotomy after the TLS because of gallbladder stones. One case was converted to an open surgery because of extensive bleeding owning to coagulation disorder. The spleen artery was ligated in 43 cases, and the hilar vessels were resected by dissecting and ligating in 45 cases. The Operation time averaged at (110?35) min (range 50-240 min), and the mean intraoperative blood loss was (160?87) ml (range, 20-1500 ml). Conclusions In spite of the prominent type Ⅱ of the spleen vessels, the spleen artery can be dissected and ligated at the level of the superior edge of the pancreatic tail to stop the blood supply to the spleen. The hilar vessels can be resected by dissecting and ligating. The spleen artery ligation and hilar vessels resection by dissecting and ligating are effective in controlling intraoperative bleeding and avoiding pancreas injury.