Laparoscopic Partial Splenectomy Research Articles

Application of Microwave Ablation in Laparoscopic Partial Splenectomy

Application of Microwave Ablation in Laparoscopic Partial Splenectomy

The safety and feasibility of laparoscopic partial splenectomy: analysis of perioperative indications from different vascular subtypes and improvement of surgical approach.

While laparoscopic splenectomy (LS) has been widely used in benign splenic tumor, more concerns have been raised for postoperatively short-term and long-term complications. Laparoscopic partial splenectomy (LPS) is a surgical option, to preserve splenic function, and reduce postoperative complications. The aim of our study was to retrospectively identify the safety and feasibility of LPS compared with LS in patients with splenic benign tumor. From 2014 to 2024, a total of 165 patients diagnosed with occupational splenic lesions underwent splenectomy, of whom 87 underwent LPS and 78 underwent LS. We compare the perioperative parameters and long term follow up between these two groups. The etiology of splenic space-occupying lesions was nonparasitic splenic cysts, followed by splenic lymphangioma and splenic hemangioma. Of the patients with LPS, 55 underwent conventional surgery with blockage of the splenic arterial branch and resection along the ischemic line (RAIL), and 32 underwent with our modified total splenic blood supply blockade followed by resection alone the tumor edge (RATE). The tumor size, the operative time and estimated blood loss were comparable between the LPS and LS groups. One patient developed abnormal signs during the LPS procedure and was promptly referred for LS. The LPS group had fewer pancreatic leakage, incision infection, and pulmonary infection. As for different vascular types, patients with LS under all branches of the splenic artery had a longer time to resume postoperative feeding. As for the comparison of RAIL and RATE, estimated blood and operative time were significantly reduced in patients receiving RATE. Postoperative complications were the same in patients underwent each surgical procedures. LPS is a viable approach for patients with splenic benign tumor. We introduce the tumor artery supply types to indicate the resection region. Our RATE technique has proven to be clinically effective and safety.

Ten-year experience of laparoscopic partial splenectomy for patients with splenic benign lesions

BackgroundThe increasing comprehension of spleen function has led to the gradual endorsement of laparoscopic partial splenectomy (LPS) as a treatment option for benign spleen lesions. However, it is important to note that the LPS technique remains challenging. This study explores the standardized process and surgical techniques in LPS, aiming to promote the application of this technique. MethodsThe clinical data of 20 patients with benign cystic or solid spleen lesions who underwent LPS at Shunde Hospital, Southern Medical University were retrospectively collected. Data include age, gender, imaging data, surgical process, and postoperative complications. Additionally, the surgical techniques and standardization process were recorded in detail. ResultsAll 20 cases completed LPS without conversion to laparotomy or splenectomy. The surgical time was 162.25 ± 37.96 min, the intraoperative blood loss was 93.00 ± 58.40 mL, no blood products were transfused during the operations, and the removed volume of the spleen was about 34.75 ± 12.19 %. There were no postoperative complications such as intra-abdominal bleeding, intra-abdominal infection, pancreatic fistula, and residual splenic infarction. Postoperative pleural effusion occurred in four cases, and symptoms improved after symptomatic treatment. The postoperative hospital stay was 7.0 ± 1.4 days. There were no perioperative deaths. The residual splenic vessels were normal during the follow-up period, and no vascular embolism occurred. ConclusionsLPS is a safe, feasible, and effective surgical method for patients with benign cystic or solid spleen lesions. Subsequently, mastering related surgical techniques and standardized surgical procedures can control the surgical risks in suitable cases, making LPS the standard procedure for treating benign spleen diseases.

Laparoscopic Partial Splenectomy May Be Valuable for the Diagnosis of Malignant Lymphoma: A Case Report.

Diagnosing primary splenic malignant lymphoma (PSML) is challenging due to the non-specific nature of splenomegaly, necessitating splenic biopsy for confirmation. However, performing partial splenic resection for diagnostic purposes is an elective procedure due to the risk of major hemorrhage. Despite the longstanding practice of splenectomy over the past few decades, it remains invasive and may result in severe early or late complications. Hence, we present laparoscopic partial splenectomy (LPS) in a patient suspicious of PSML for diagnostic purposes in this study. An 81-year-old woman presented to our hospital with a one-month history of fever and dry cough. Atypical cells had been detected in her peripheral blood nine months ago. However, at that time, a bone marrow examination did not reveal any atypical cells. The laboratory tests revealed a soluble interleukin receptor-2 levels of 4,667 U/dl and atypical cells were also found in peripheral blood. Abdominal computed tomography showed splenomegaly without any other relevant findings. These findings are suspicious of PSML and LPS without vessel ligation was performed and a small fraction of the spleen from the inferior pole measuring 1.8×1.0 cm was resected. The operation lasted for 63 min with minimal estimated blood loss. Histopathological findings were compatible with the diagnosis of diffuse B-cell lymphoma. The postoperative clinical course was uneventful, and splenomegaly demonstrated improvement six months after the operation. LPS without vessel ligation for biopsy may be valuable for the diagnosis of malignant lymphoma, particularly when there are no swollen lymph nodes, as it offers a less invasive approach.

Laparoscopic partial splenectomy in the treatment of splenic ectopic pregnancy.

Laparoscopic partial splenectomy in the treatment of splenic ectopic pregnancy.

Laparoscopic partial splenectomy in the treatment of splenic ectopic pregnancy.

Laparoscopic partial splenectomy in the treatment of splenic ectopic pregnancy.

Clinical comparative study of laparoscopic partial splenectomy and open partial splenectomy.

The aim of the article was too investigate and compare the feasibility, safety, and early postoperative recovery associated with laparoscopic partial splenectomy (LPS) and open partial splenectomy (OPS) in patients with benign splenic tumours and traumatic splenic rupture. A retrospective analysis was conducted on clinical data from 110 patients undergoing splenic resection at our hospital between March 2019 and May 2022. Among them, 35 patients underwent OPS, 25 underwent LPS for traumatic splenic rupture, while 50 patients with benign splenic tumours underwent either OPS (n = 20) or LPS (n = 30). Preoperative, intraoperative, and postoperative data were collected and compared. Statistical analysis was conducted using SPSS software. There was no significant difference in the general data between the 2 groups of patients with benign splenic tumours and those with splenic trauma. Among patients with traumatic splenic rupture, the OPS group had a shorter operation time (p < 0.05). Regardless of whether they had traumatic splenic rupture or benign splenic tumours, the LPS group required less postoperative analgesia and had a shorter defecation recovery time (p < 0.05). Additionally, the LPS group displayed lower white blood cell count, white blood cell/lymphocyte ratio (WLR), neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), C-reactive protein (CRP), calcitonin (PCT), and interleukin-6 (IL-6) than the OPS group on the first and third days post-surgery (p < 0.05). In comparison to OPS, LPS presents significant advantages, including minimal surgical trauma, a reduced early postoperative inflammatory response, milder wound pain, and a faster recovery of gastrointestinal function.

Laparoscopic partial splenectomy for sclerosing angiomatoid nodular transformation: A case report and literature review

Abstract Laparoscopic partial splenectomy has become the preferred method for benign disease or low-grade malignancy with advantages of organ preservation and avoidance of potential postsplenectomy fulminant infection. We herein presented a presumed diagnosis of sclerosing angiomatoid nodular transformation subjected to laparoscopic partial splenectomy. The patient underwent the surgical procedure uneventfully and was discharged at day 4 postoperatively. The diagnosis was confirmed by the pathological examination.

Laparoscopic partial splenectomy in distal pancreatectomy may preserve splenic function.

Splenectomy is known to carry a risk of infection with encapsulated organisms and associated sepsis. Current Australian guidelines recommend intensive vaccination schedules and long-term antibiotic therapy. We postulate that in some clinical scenarios where distal pancreatectomy (DP) and splenectomy is being performed, a partial splenectomy is feasible. This may preserve splenic function and help retain immunocompetence. Five patients underwent laparoscopic distal pancreatectomy with partial splenectomy (LDPPS). The DP is performed with proximal division and resection of the splenic artery and vein. The inferior portion of the spleen is removed en bloc with the distal pancreas with ligasure and linear cutting staplers. The line of demarcation on the spleen after the division of the splenic artery identifies the portion supplied by the short gastric vessels. Temporary clamping of the short gastrics during splenic parenchymal transection reduces blood loss. All operations were completed laparoscopically and within 4 h. The pathology of resected lesions includes a serous cystadenoma, a pseudocyst, an IPMN and two small medial pancreatic ductal adenocarcinomas. The benign lesions involved splenic vessels at the hilum, making Kimura or Warshaw procedures untenable. No patient required blood transfusion. One patient suffered a postoperative collection consistent with postoperative pancreatic fistula requiring a drain for 10 days. Follow-up ranged from 6 to 24 months. Following surgery, all patients had a perfused splenic remnant on imaging and benign blood films, which suggests retained splenic function. Preserving some spleen when performing distal pancreatectomy may provide long-term benefits for patients.

Totally laparoscopic partial splenectomy and gastropexy for a splenic cyst in a wandering spleen.

With only seven reported cases until 2019 as noted by Lim et al., cases of a wandering spleen (WS) accompanied by splenic cyst (SC) are exceptionally rare. Furthermore, both entities are notoriously 'silent' until they present as an emergency with complications, often warranting total splenectomy. Management of SC in a WS eventually depends on its clinical presentation, disease type and functional reservoir of the spleen. However, it is desirable to operate electively and perform a spleen salvage with splenic reposition surgery. Our case describes the first totally laparoscopic partial splenectomy and intraperitoneal fixation of the spleen by means of gastropexy for a large non-parasitic SC in a WS. Partial splenectomy instead of just a cystectomy tackles the risk of cyst recurrence, and a gastropexy over other splenic repositioning techniques would allow the spleen to remain as an intraperitoneal organ.

Robotic-Assisted and Laparoscopic Splenectomy in Children: A Single Center Comparative Study.

Background: To explore the safety, efficacy, advantages, and disadvantages of robotic-assisted splenectomy (RS) in children by analyzing and comparing the clinical data of RS and laparoscopic splenectomy (LS). Methods: The clinical data of 35 children who underwent laparoscopic or RS or partial splenectomy from February 2010 to October 2022 were included. A retrospective analysis based on general information, clinical data, and prognosis were performed. Results: Among 35 cases, 14 cases, and 21 cases underwent RS and LS, respectively. The average operation time was 167 (120-224) minutes in the RS group and 176 (166-188) minutes in the LS group. The intraoperative blood loss was significantly larger in LS group than RS group (P = .0009). The length of hospital stay was significantly longer in LS group than RS group (P = .0015), and the hospitalization cost was significantly higher in RS group than LS group (P < .0001). There were no cases of conversion to laparotomy in the RS group, but two cases in the LS group. In terms of postoperative complications, there were one and three cases in the RS and LS groups, respectively. Conclusion: The Robotic Surgical System was safe and feasible in pediatric splenectomy or partial splenectomy which was an alternative to laparoscopic surgery.

Epidermoid Splenic Cyst in Children Treated by Laparoscopic Partial Splenectomy: Three Case Reports and Literature Review

Epidermoid Splenic Cyst in Children Treated by Laparoscopic Partial Splenectomy: Three Case Reports and Literature Review

Retrospective assessment of the clinical efficacy of laparoscopic partial splenectomy.

The present study aimed to explore the clinical efficacy of laparoscopic partial splenectomy in the treatment of benign lesions of the spleen and partial splenic rupture. The clinical value of laparoscopic partial splenectomies performed between March 2015 and May 2022 was retrospectively analyzed. Cases considered included the following: 14 spleen cysts, five spleen hemangiomas, one spleen hamartoma and two splenic ruptures. Lesion diameters of cases ranged from 5.0-11.3 cm. Results indicated that all 22 patients had an uneventful surgery, including 11 cases with lesions located in the upper pole of the spleen, nine in the lower pole of the spleen, one in the upper middle pole and one in the middle and lower pole. Operation time ranged from 75-180 min (mean: 120±17 min) and intraoperative bleeding ranged from 80-300 ml (mean: 178±70 ml). The average duration of postoperative hospitalization was 6±2 days, with all patients followed up for 10-12 months. Patients reported no symptoms of discomfort and had platelet levels within normal range. In conclusion, laparoscopic partial splenectomy allows for lesion resection while retaining normal splenic function and may be effectively used for treating benign spleen tumors and partial splenic rupture. However, the operation is difficult and surgeons must be able to perform minimally invasive techniques and strictly screen cases.

Bloodless Laparoscopic Partial Splenectomy Assisted by Bipolar Radiofrequency Excision Hemostatic Device.

Among the lymphatic system in the human body, the spleen is the most extensive one and has hematopoietic, hemofiltration, blood storage, and immune functions. As a new method of preserving the spleen, laparoscopic partial splenectomy (LPS) has been increasingly applied in clinical practice with people's deeper insights into minimally invasive treatment and the development of technical equipment. Compared with conventional open splenectomy, LPS can preserve normal spleen tissue as much as possible, decrease the occurrence of complications after total splenectomy, and reduce postoperative hospital stay. The bipolar radiofrequency excision hemostatic device used for LPS can solidify the splenic tissue and close the small blood vessels, which reduces the hemorrhage of the spleen cross-section and clears the operative field, thus achieving the ideal effect of "bloodless partial splenectomy". Therefore, under the premise of strictly mastering the indications and fully understanding the vascular anatomy of the spleen, the application of the bipolar radiofrequency excision hemostaticdevice in LPS is worthy of clinical promotion.

Laparoscopic management of benign splenic tumors in children

BackgroundThe splenic tumor is relatively rare in children. However, diagnosing and managing this disease remain controversial. This study aimed to evaluate the clinical characteristics and pathological features of benign splenic...

Large splenic epithelial cyst: A rare presentation.

Introduction and importanceSplenic cysts are infrequent and most of them are related to parasitic diseases. Splenic epithelial cyst (SEC) is the most common type of primary non-parasitic splenic cysts. Its pathogenesis is not yet clear. Splenic cysts are usually asymptomatic and are detected incidentally during imaging exams or an exploratory laparotomy.Case presentationOur case is about a primary SEC discovered incidentally. An 18-year-old male patient without any personal and family medical history, presented with symptoms of upper urinary tract infection. Renal ultrasound was performed and found incidentally a solitary cystic lesion in the spleen. A laparoscopic partial splenectomy was made then. The specimen was sent for pathological examination and a diagnosis of primary (epidermoid) epithelial splenic cyst was given.Clinical discussionSEC is a rare pathology that could mimic other splenic cysts like hydatid cyst. The preoperative diagnosis of SEC can be suspected by ultrasonography, computed tomography or magnetic resonance imaging. However, histopathological examination is mandatory to confirm the diagnosis. A wide range of differential diagnoses is considered when we suspect clinically SEC because of its lower incidence.ConclusionActually, spleen-preserving surgery with minimally invasive methods such as laparoscopy is the gold standard for the treatment of SEC despite the risk of recurrence encountered with these techniques. However, different surgical modalities are discussed depending on the size and the location of the cyst and the patient's age.

Laparoscopic partial splenectomy for symptomatic benign cystic lesions: technical notes.

The purpose of this study was to explore the feasibility of laparoscopic partial splenectomy in patients with symptomatic benign lesions. During the period from April 2017 to February 2020, a single surgeon performed 7 LPS for benign lesions. As primary endpoint, we retrospectively analyzed the patient's short-term outcome and the operative results. As secondary endpoints, we considered 6-month follow-up. Laparoscopic partial splenectomy was performed successfully in all cases, with no major complications. Thirty-day mortality was nil. No post-operative transfusions were required and the median hospital stay was 4 (range 3-5) days. The median operative time was 110 (range 75-140) min and there was neither conversion to open surgery nor need for total splenectomy. Mean blood loss was 135.7 ± 103.6ml and no intraoperative blood transfusions were necessary. All patients recovered successfully, with significant decrease of Ca 19.9 (98.22 ± 118.10 U/mL vs. 4.78 ± 3.35 U/mL, P = 0.015) and normal platelet count (215.7 × 103 ± 42.2 × 103 per µL vs. 236.0 × 103 ± 58.3 × 103 per µL, P = 0.285) at 1-month follow-up. No cases of recurrence were detected during the 6-month follow-up. Laparoscopic splenic resection for benign lesions is a challenging but feasible procedure. This technique combines the advantages of both mini-invasive surgery and spleen preservation.

Clinical effect of laparoscopic partial splenectomy for both benign tumours and trauma-10 years of experience at a single institution.

This retrospective study aimed to present our surgical experience in patients with benign tumour or trauma in spleen who underwent laparoscopic partial splenectomy (LPS) and to compare the results with those of patients who underwent an open partial splenectomy (OPS). We analysed the medical data of patients who underwent LPS or OPS between January 2010 and January 2020. In total, 41 patients were enrolled. Nine patients underwent open surgery, 32 patients underwent laparoscopic surgery. The proportion of patients with tumours in the upper pole in LPS group was more than patients in OPS group. No difference was observed in estimated blood loss, allogeneic transfusion, postoperative stay, pathology and complications between LPS and OPS groups. The operation time in the LPS group (137.5 ± 30.8min) was longer than that in the OPS group (88.3 ± 30.1min) for patients with splenic traumatic rupture (P=0.019). LPS is an effective and safe spleen-preserving surgery as OPS. The advantages are small trauma, light pain and quick recovery. It is suitable for patients with benign tumours or trauma confined to one side of the spleen.

Minimally Invasive Partial Spleen Resection Preserving the Lower Pole in Children: A Technical Report on Feasibility and Safety.

Background: Laparoscopic partial splenectomy is a surgical option for removing part of the spleen with a pathological mass in a way that ensures preservation of the spleen's physiological functions. We aimed to evaluate the efficacy and feasibility of this procedure, performed while preserving the blood supply from the left gastroepiploic artery, in children. Materials and Methods: Following institutional review board approval, this retrospective study was conducted on patients who, between January 2015 and December 2019, underwent laparoscopic partial splenectomy with preservation of blood supply from the left gastroepiploic vessels. In the article, we described patient indications for surgery, surgical technique, surgery time, complications, and follow-up outcomes. Results: Eleven patients (mean age: 12.3 ± 3.4 years) underwent laparoscopic partial splenectomy. Indications for surgery included nonparasitic cysts (n = 8), pseudocysts (n = 2), and hamartomas (n = 1). The mean benign mass diameter was 60 ± 22 mm. The mean operative time was 193.2 ± 55.1 minutes. The mean size of the retained lower pole was 31.1% ± 3.8%. There was no conversion to open splenectomy or any significant complication. The mean postoperative stay was 9 ± 0.7 days. No thrombosis of the splenic and portal veins was noted in the follow-up period, and no splenic remnant infarction occurred. Conclusions: Laparoscopic partial splenectomy with preservation of blood supply arising from the left gastroepiploic vessels seems to be safe in children. However, a larger study is needed to confirm our results.

Effectiveness of Articulating Linear Stapler for Total and Partial Laparoscopic Splenectomy in Children.

Purpose: We performed a retrospective study to determine the effectiveness and feasibility of articulating linear stapler in laparoscopic total splenectomy (LTS) and laparoscopic partial splenectomy (LPS), focusing on technical laparoscopic skills that could help pediatric surgeons to avoid intra- and postoperative complications. Methods: Retrospective cohort study of children younger than 18 years who underwent laparoscopic spleen surgery between January 2008 and March 2020. Age, sex, indication for surgery, operative time (OT), intra- and postoperative complications, and postoperative length of hospital stay (LHS) were analyzed. Data from parenchymal resection and vessels sealing techniques were obtained. Results: Thirty patients, 19 LTS and 11 LPS, were included. The mean age of the patients was 10.9 years, and 16 patients were male and 14 were female. For hematologic diseases, LTS was the elective surgery, associated with cholecystectomy in 5 cases. LPS was the common procedure for splenic cysts. The stapler was used in LTS to close the hilum vessels and in LPS for parenchymal resection. No statistically significant differences in OT were observed comparing LTS and LPS. Two conversions occurred in LTS; none in LPS. The mean LHS was 6 days in both groups. No recurrence or major complications appeared in both groups at 1-12 years of follow-up. In particular for LPS, there are no relapse of cyst neither reduction in splenic function. Conclusions: This study shows the effectiveness, feasibility, and safety of mechanic stapler in splenic surgery both for hilum vessels sealing and for parenchymal resection. The use of this device can reduce risk of hemorrhagic recurrences or major surgical complications improving the safety of the operation.