Application value of secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail in laparoscopic partial splenectomy

Abstract

Objective To investigate the application value of secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail in laparoscopic partial splenectomy. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 13 patients who underwent laparoscopic partial splenectomy in the Ningbo First Hospital from March 2016 to October 2017 were collected. After preoperative assessment using computed tomography(CT) angiography, 13 patients underwent laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail. Observation indicators: (1) intra- and post-operative recovery situations; (2) follow-up situations. Follow-up using outpatient examination was performed to detect postoperative changes of peripheral blood platelet (PLT), thrombosis of splenic vein, lesions residual or recurrence up to November 2017. Measurement data were represented as average (range). Results (1) Intra- and post-operative recovery situations: 13 patients underwent successful laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail, without conversion to open surgery, including 6 with laparoscopic partial splenectomy of inferior pole of the spleen and 7 with laparoscopic partial splenectomy of upper pole of the spleen. Operation time was 42-93 minutes, with an average of 61 minutes; volume of intraoperative blood loss was 30-260 mL, with an average of 92 mL; postoperative gastrointestinal function recovery time was 22-47 hours, with an average of 34 hours; postoperative drainage tube removal time was 3.0-6.0 days, with an average of 4.2 days. The postoperative pathological examination of 13 patients: 7, 2, 2, 1 and 1 patients were respectively confirmed with splenic cysts, splenic hemangiomas, vascular hemangiomas, splenic hamartoma and splenic lymphangioma. Of 13 patients, 1 was complicated with splenic recess effusion and fever, and was improved with B ultrasound-guided percutaneous catheter drainage. Duration of hospital stay of 13 patients was 7.0-16.0 days, with an average of 9.6 days. (2) Follow-up situations: 13 patients were followed up for 1.0-19.5 months, with a median time of 8.5 months. During the follow-up, PLT level of 13 patients was normal. Color Doppler ultrasound examination showed no venous embolism, and CT angiography showed good vascular perfusion. There was no recurrence of splenic cysts in 7 patients and no tumor residual or recurrence in 6 patients. Conclusion Laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail is safe and effective, and it can precisely dissect splenic hilum, preserve blood supply and function of the remnant spleen, and reduce surgical injury. Key words: Splenic neoplasms, benign; Partial splenectomy; Secondary splenic pedicle separation; Superior posterior approach of the pancreatic tail; Laparoscopy