Laparoscopic Assisted Splenectomy for Treatment of Presumed Immune Thrombocytopenic Purpura: Initial Results

Abstract

To present the initial results of performance of laparoscopic splenectomy in two patients at Mayo Clinic Scottsdale. We describe two 18-year-old patients with idiopathic immune thrombocytopenic purpura and the technique of laparoscopic splenectomy used for treatment. For adequate visualization of the spleen and exposure of the upper midline area should urgent laparotomy become necessary, we position the patient supine with a sandbag under the left lower costal margin. Insertion of five 10-mm trocars facilitates placement of instruments. Dissection of the spleen is begun inferiorly. The splenic flexure of the colon is reflected inferiorly, and the spleen is rotated anterolaterally to allow division of the gastrosplenic ligament and the splenic hilum. Individual vessels are divided between clips, as are the short gastric vessels. Cautery is used for dividing the splenophrenic ligament. The spleen is placed in a plastic bag, and the open end of the bag is delivered through the umbilical incision, after which the spleen is morcellated and then removed. Considerable care must be exercised to ensure that the plastic bag is not punctured and that no ectopic splenic tissue is present. Both laparoscopic splenectomies were successful, and no intraoperative or postoperative complications occurred. After dismissal on postoperative day 3, the patients quickly resumed all activities. The platelet counts returned to normal. These encouraging results support the use of laparoscopic splenectomy for immune thrombocytopenic purpura and suggest that this procedure may have a role in patients with other conditions of the spleen.