Technique for Spleen Resection Using Radiofrequency Ablation

Stepanova Yulia Aleksandrovna,Ionkin Dmitry,Alimurzaeva Maksalina Zakaryaevna,Vishnevsky Vladimir Aleksandrovich

doi:10.31487/j.scr.2021.03.06

Abstract

From modern positions, removal of the spleen is undesirable due to the risk of post-splenectomy syndrome development, where first of all, the clinical manifestations of the syndrome of suppressive post-splenectomy infections are taken into account, which justifies either performing organ-preserving surgical interventions on the spleen, or heterotopic autotransplantation of spleen tissue. Spleen resection is accompanied by significant blood loss, both during the intervention and in the postoperative period. The various methods of prevention of bleeding (clips, coagulation instruments, local hemostatics, etc.) are not always effective. Currently, there have been reports of the possibility of using radiofrequency ablation (RFA) in interventions on the spleen. The literature data and own 10 observations of spleen resection with the use of RFA in patients with focal organ lesions are presented. All described in literature technologies use the Rita® device for RF destruction and the corresponding attachment, which consists of 4 needle active electrodes. The spleen parenchyma is "burned" blindly, and the organ parenchyma is divided in the middle, between the treated injections. A new technique for performing spleen resection using radiofrequency ablation has been proposed at A.V. Vishnevsky National Medical Research Center of Surgery. The essence of our proposed method for minimizing blood loss during spleen resection is as follows: RFA-exposure is carried out along the zone of organ ischaemia under the control of ultrasound. For RFA, we used a Radionics Cool-Tip® Ablation System and a set of water-cooled electrodes (MEDTRONIC, USA). The features of the surgical intervention are noted. No bleeding was noted either intraoperatively or in the postoperative period in any case. A comparative analysis of the results of various methods of organ-saving surgical treatment is presented.

Highlights

Until recently, tumor and cystic lesions of the spleen were considered relatively rare diseases, which were diagnosed only with large sizes or the development of complications
Splenectomy had no alternative in spleen surgery; it is still dogma for a number of medical schools
The diagnosis of a benign focal lesion of the spleen was established based on the results of a comprehensive preoperative examination

Summary

Introduction

Tumor and cystic lesions of the spleen were considered relatively rare diseases, which were diagnosed only with large sizes or the development of complications. A small individual experience in the treatment of spleen tumors and cysts makes it difficult to choose a timely and adequate treatment method or the optimal amount of surgery. This is reflected in the contradictions existing on the pages of the press regarding the choice of the method of treatment, the principles of examination, the details of the operative technique, the criteria for monitoring the state of patients in the postoperative period. It should be admitted that in general practice, organ-saving spleen surgeries are not yet popular, for traumatic injuries and for benign tumors and cysts of the spleen. Behind this lies the neglect of a wide range of vital functions of the spleen and the possible consequences of its loss

Methods

Results

Conclusion