Aim - to conduct a literature review analysis on accessory spleens in children and to establish the prevalence, number and localization, as well as modern visualization methods, features of the course and significant indications for surgical treatment. Accessory spleens account for 10% to 30% of the population. The prevalence of additional spleens was established, which varied depending on the imaging method: verification using ultrasound, computer tomography, magnetic resonance imaging took place from 16.6% to 30.1%, intraoperative from 14.3% to 14.6%, and cadaveric from 0.6% to 9.1%. By the number of additional spleens, it was established that one additional spleen took place from 21.4% to 85%, and two or more from 25.0% to 64.3%. Additional spleens were localized in the splenic hilum from 41.7% to 75%, in lig.gastrolienale 15.0% to 54.0%. Surgical treatment - removal of the additional spleen is indicated only if it is complicated by volvulus, necrosis and suppuration, and isolated cases are described as clinical observations. There were 195 patients with additional spleens for 30 years, aged from 3 months to 18 years, of which 103 (52.82%) were male, 92 (47.18%) were female. Patients were divided into two groups: the first group 59 (30.26%) - inpatient surgical treatment of other ailments, the second group - 136 (69.74%), who were treated on an outpatient basis. Conclusions. An additional spleen is a congenital anomaly that is usually asymptomatic, but can clinically manifest complications such as torsion, spontaneous rupture with bleeding, suppuration and cyst formation, which requires urgent examination and treatment, including surgical removal of the twisted additional spleen. The authors declare no conflict of interest.

The patterns of tryptase normalization, KITD816V clearance and establishment of donor cell chimerism were analysed in 13 patients with systemic mastocytosis and associated haematological neoplasm (AHN) after haematopoietic cell transplantation (HCT). The molecular marker of systemic mastocytosis (SM) (KITD816V) simultaneously disappeared (median + 36 days) with the establishment of donor chimerism (median: +31 days post-HCT; Pearson correlation: -0.99, p < 0.001). In contrast, tryptase normalized median of +228 days after HCT with significant delay to KITD816V clearance (p = 0.01) and full donor chimerism (p = 0.04). Faster normalization was observed after radiation-based conditioning and removal of an infiltrated spleen, while persistence was not associated with relapse of AHN.

Abstract. Introduction. Hereditary microspherocytosis (HMS) is a disorder characterized by defects in erythrocyte membranes, leading to their destruction in the spleen and disturbances in bilirubin metabolism. Among the most common complications of HMS is cholelithiasis. Splenectomy (SE) and laparoscopic cholecystectomy (LC) are effective treatment methods. The aim of the study is to evaluate the effectiveness of simultaneous surgeries (SS) using laparoscopic techniques in the combination of cholelithiasis and hereditary microspherocytosis (HMS). Materials and methods: In 13 patients with hereditary microspherocytosis (HMS), cholelithiasis was diagnosed, and these patients underwent simultaneous splenectomy (SE) and cholecystectomy (CE). All patients underwent comprehensive laboratory and instrumental diagnostics. In 5 patients, laparoscopic access was used for simultaneous surgery (LCE + LSE), while in 8 patients, a hybrid procedure was performed (LCE + laparotomic SE). Video laparoscopic surgical interventions were performed using the Karl Storz system (Germany). Intraoperatively, the “Harmonic Scalpel Ultracision” ultrasonic device (Ethicon, USA) was used as a dissector and coagulator, while Endo-GIA staplers (Autosuture, USA) were used for vascular pedicle management of the spleen. Results and discussion: In 8 patients, simultaneous surgery (SS) was performed using a hybrid technique that combined laparoscopic and laparotomic access. In 5 patients, SS was performed entirely using the laparoscopic method. Spleen mobilization with an ultrasonic scalpel was carried out quickly, as the division of ligaments and adhesions was not accompanied by bleeding. Proper preoperative preparation, the correct choice of surgical access and technique for combined SE and CE using an ultrasonic scalpel and stapling device, along with adequate postoperative therapy, help prevent technical errors, postoperative complications, and significantly improve outcomes in patients with HMS. The simultaneous performance of SE and CE does not increase the severity of the surgical procedure or the postoperative course. Conclusions: 1. The use of an extended diagnostic program for hereditary microspherocytosis (HMS) complicated by cholelithiasis allows for a well-founded determination of surgical tactics and the selection of the optimal surgical approach. The use of an ultrasonic scalpel and linear stapler during splenectomy in patients with HMS significantly facilitates spleen mobilization, reduces intraoperative blood loss, and minimizes the risk of intraand postoperative complications. The application of laparoscopic and hybrid techniques for simultaneous surgery (SS) in HMS complicated by cholelithiasis helps avoid the need for repeat surgical intervention, ensures high treatment efficacy, and provides significant medical and social benefits compared to performing two separate procedures.

Background and objectives: Immune thrombocytopenic purpura (ITP) is a rare hematological disorder characterized by an autoimmune-mediated decline in platelet count in peripheral blood. Over the years, its treatment has evolved, leading to a decline in the role of splenectomy, which was previously used as a second-line therapy. This study aims to evaluate the effects of spleen removal on the progression of the disease, regardless of the surgical procedure, by presenting a single-center experience. Materials and Methods: We retrospectively reviewed the medical records of all ITP patients who underwent splenectomy and were admitted to the Hematology Clinic of Timișoara Emergency City Hospital between January 1988 and June 2024. A total of 217 ITP patients who underwent splenectomy were identified over a 37-year period. Demographic data, postoperative complications, and responses to splenectomy were analyzed over a median follow-up period of 93.86 ± 104.25 months, ranging from 6 to 423 months. Results: Among the 217 patients included in the study, 155 (71.42%) were female and 62 (28.58%) were male, with a mean age of 38.47 ± 16.12 years. During the follow-up period, a significant decrease in the number of splenectomies was observed (p < 0.001). The overall morbidity rate was 14.28%. The overall response rate after splenectomy was 85.71%, with 158 patients (72.81%) achieving a complete response and 28 (12.90%) achieving a partial response. However, 28 (15.05%) of the responsive patients experienced relapse during follow-up and required additional medical therapy. Analyzing the association between comorbidities and relapse after splenectomy, the presence of diabetes (OR = 6.90, 95% CI: 2.87-16.58), hepatic diseases (OR = 64.60, 95% CI: 19.60-212.91), immune thyroid disorders (OR = 8.37, 95% CI: 2.09-33.46), and obesity (OR = 10.22, 95% CI: 3.41-30.60) were identified as risk factors for relapse using univariate analysis. Conclusions: Splenectomy remains the treatment with the best long-term outcomes compared to other therapies. However, concerns about early and late complications following splenectomy, along with advancements in modern ITP treatments, have led to a significant decline in the number of splenectomies performed. In univariate analyses, female gender, age over 40, and the presence of diabetes, hepatic diseases, obesity, or immune thyroid disorders were found to be risk factors for relapse following splenectomy. In the logistic regression analysis adjusted for age and sex, obesity and steatosis were significantly associated with an increased risk of relapse after splenectomy in women over 40 years of age.

Vagus nerve (VN) and spleen dysfunctions are often associated with obesity (Ob). Aim: We evaluated the effects of VN and spleen ablation on adiposity, metabolism, and insulin secretion in hypothalamic obese male rats. Methods: Ob was induced by neonatal subcutaneous injection of monosodium glutamate (4 g/kg). At 60 days of life, Ob animals were randomly distributed into four groups (n = 16 rats/group): sham operation (SHAM), vagotomy (VAG), splenectomy (SPL), and VAG + SPL. Body weight and food intake were monitored for 8 weeks postsurgery. Intraperitoneal glucose tolerance test (ipGTT) and intraperitoneal pyruvate tolerance test (ipPTT) were performed at 148 days of life, and VN activity was recorded at 150 days. After euthanasia (150 days), adiposity, plasma biochemical parameters, glucose-induced insulin secretion (GIIS), and cholinergic and adrenergic islet responsiveness were evaluated. The pancreas was submitted for histopathological analysis, and the protein content of OXPHOS and IL-10 was evaluated in isolated pancreatic islets. Results: Decreased VN activity was confirmed in the Ob-VAG groups, associated with lower visceral adiposity, triglycerides, and plasma insulin, together with improved insulin sensibility and pyruvate tolerance, compared to Ob-SHAM rats. Spleen absence reduced VN activity and cholinergic insulinotropic responses, with deleterious effects on the endocrine pancreas. Furthermore, Ob-VAG + SPL rats presented greater reductions in GIIS and more severe endocrine pancreas histopathology, compared to the Ob-SHAM group, without altered islet size or number or protein content of OXPHOS or IL-10. Conclusion: Vagal and splenic interactions contribute to glucose homeostasis control in hypothalamic obese rats, modulating insulin secretion and pancreas histology.

In mammals, the liver and spleen are closely related to each other and form the so-called liver-spleen axis. The functioning of this axis is based on anatomical connection through portal circulation, as well as the commonality of many functions performed. The connection between the liver and spleen is most pronounced in the development of such pathologic conditions as fibrosis and cirrhosis. Some clinical and experimental studies found that removal of the spleen leads to a decrease in the severity of liver fibrosis. A positive effect of spleen removal has also been found in liver resection and liver transplantation. Different authors suggest several mechanisms of this effect. It is assumed that the spleen in the development of fibrosis becomes an additional source of cytokines damaging the liver. In addition, monocytes and other leukocytes that support inflammation may migrate from the spleen to the liver. Another mechanism may be a decrease in blood pressure levels in the hepatic portal vein after splenectomy. Despite the available evidence, the mechanisms of this effect remain poorly understood. This issue is relevant for biomedical research, as it may form the basis for the development of new ways to treat liver diseases and stimulate its regeneration.

Background: The lesser grison (Galictis cuja) is a mammalian species belonging to the mustelid family, commonly found in Brazilian zoos and rehabilitation centers. Despite the high prevalence of this species in Brazil, information on the diseases affecting these animals and their respective treatments is limited. This underscores the importance of case reports in this context. While splenic torsions are considered rare and are more commonly diagnosed and reported in dogs, they can also occur in other species, such as ferrets. Clinical signs are nonspecific, complicating the diagnosis, which is typically achieved through ultrasound with color Doppler assistance, revealing parenchymal, positional, and blood flow alterations, or therapeutic diagnosis through exploratory celiotomy. The aim of this study is to report a clinical and surgical case of primary splenic torsion in a lesser grison (G. cuja) from a zoo in southern Brazil. Case: A 8-year-old, uncastrated, 1.4 kg animal presented with a history of lethargy, anorexia, vomiting, and diarrhea. Clinical examination revealed dehydration and moderate abdominal pain, with palpation suggestive of splenomegaly and spleen displacement. The animal was hospitalized for treatment, and a complete blood count, biochemical tests, and abdominal ultrasound with color Doppler were performed. The blood test indicated anemia, while the abdominal ultrasound revealed an enlarged spleen in an atypical location, displaced cranially and to the right, with negative Doppler color signal throughout the organ. Surgical intervention was chosen, utilizing conventional splenectomy. Physical restraint was achieved with leather gloves and a snare. Anesthetic induction was performed with intravenous propofol, followed by periglottic anesthesia with lidocaine upon loss of eyelid and mandibular reflexes. Orotracheal intubation used a 2.5 tube. Transverse abdominal plane block with lidocaine at 6 mg/kg was administered at 2 points lateral to the incision site. General anesthesia was maintained with vaporized isoflurane in 100% oxygen at variable rates (0.4 to 0.8%). Exploratory celiotomy began with a pre-umbilical mid-ventral incision of 5 cm, accessing the abdominal cavity through the linea alba. After locating and exteriorizing the spleen, torsion of vessels in the splenic hilum region was observed. No complications occurred during the procedure, and the animal had a smooth anesthetic and surgical recovery. Discussion: Despite the preferred treatment for dogs with splenic torsion being splenectomy, there are disagreements among authors. Some advocate for detorsion of the spleen and assessment of associated injuries before opting for removal if the organ remains functional. The spleen returns to its normal size within minutes, but its normal position cannot be guaranteed, and there is no way to prevent future torsion. Moreover, detorsion may allow toxic material from necrosis to enter circulation, justifying the preference for spleen removal by some authors. In conclusion, diagnostic methods involving ultrasound, along with color Doppler, confirmed by exploratory celiotomy, and the chosen surgical technique, were satisfactory for treating the reported case. Keywords: Mustelidae, spleen, acute abdomen, ultrasonography. Título: Torção esplênica primária em furão-pequeno (Galictis cuja) Descritores: Mustelidae, baço, abdômen agudo, ultrassonografia.

The article shows the results of 12 pregnant women with a complication of idiopathic thrombocytopenic purpura in the form of hemorrhagic syndrome. Their clinic, diagnosis, conservative and surgical treatment. Traditional and inhalation injection of glucocorticoid hormones, as well as intravenous injection of immunoglobulin in 75% of patients had positive effect and remission was obtained on days 3-4. If the conservative treatment was ineffective, surgeries were performed splenectomy (SE), and uterine bleeding stopped on 2-3 days and platelets increased to 210 thousand. During pregnancy, patients with idiopathic thrombocytopenic purpura (ITP), complicated by hemorrhagic syndrome, conservative and surgical treatment in 100% of cases performed a positive effect.

Total metabolic tumor volume (TMTV) is prognostic in lymphoma. However, cutoff values for risk stratification vary markedly, according to the tumor delineation method used. We aimed to create a standardized TMTV benchmark datasetallowing TMTV to be tested and applied as a reproducible biomarker. Methods: Sixty baseline 18F-FDG PET/CT scans were identified with a range of disease distributions (20 follicular, 20 Hodgkin, and 20 diffuse large B-cell lymphoma). TMTV was measured by 12 nuclear medicine experts, each analyzing 20 cases split across subtypes, with each case processed by 3-4 readers. LIFEx or ACCURATE software was chosen according to reader preference. Analysis was performed stepwise: TMTV1 with automated preselection of lesions using an SUV of at least 4 and a volume of at least 3 cm3 with single-click removal of physiologic uptake; TMTV2 with additional removal of reactive bone marrow and spleen with single clicks; TMTV3 with manual editing to remove other physiologic uptake, if required; and TMTV4 with optional addition of lesions using mouse clicks with an SUV of at least 4 (no volume threshold). Results: The final TMTV (TMTV4) ranged from 8 to 2,288 cm3, showing excellent agreement among all readers in 87% of cases (52/60) with a difference of less than 10% or less than 10 cm3 In 70% of the cases, TMTV4 equaled TMTV1, requiring no additional reader interaction. Differences in the TMTV4 were exclusively related to reader interpretation of lesion inclusion or physiologic high-uptake region removal, not to the choice of software. For 5 cases, large TMTV differences (>25%) were due to disagreement about inclusion of diffuse splenic uptake. Conclusion: The proposed segmentation method enabled highly reproducible TMTV measurements, with minimal reader interaction in 70% of the patients. The inclusion or exclusion of diffuse splenic uptake requires definition of specific criteria according to lymphoma subtype. The publicly available proposed benchmark allows comparison of study results and could serve as a reference to test improvements using other segmentation approaches.

Background To date, there is limited knowledge of patients with idiopathic splenomegaly in pregnancy, and the literature lacks cases of a combined cesarean section with splenectomy. The documented cases of splenomegaly in pregnancy often have infectious etiology such as that of malarial infection or an autoimmune component such as idiopathic thrombocytopenic purpura. This condition is life-threatening and complicates medical management, but its rarity has led to a paucity of management guidelines for patients with idiopathic splenomegaly in pregnancy. Objective The aim of this case is to provide novel insight into the management and outcomes of patients with idiopathic massive splenomegaly in pregnancy. Study Design This study is a case report with a review of the current literature on the reported cases of splenomegaly in pregnancy, splenectomy in pregnancy, and cesarean section with splenectomy. This case describes a history of pancytopenia and massive splenomegaly in a pregnant patient who underwent extensive workup with no clear etiology. This case additionally describes the course of care for this patient, including a combined cesarean section with splenectomy. We searched PubMed for all English language articles from 2000 to 2023, with search terms including “splenomegaly in pregnancy,” “splenectomy in pregnancy,” and “cesarean section and splenectomy.” Results In this patient’s case, despite an exhaustive infectious disease workup and evaluation for hematologic, inflammatory, and neoplastic causes, no clear etiology was identified. Delivery was deemed necessary at 34 weeks and 2 days gestation due to the patient’s severe, persistent pain, her worsening pancytopenia, and the risk of spontaneous splenic rupture during labor and delivery; our multidisciplinary team concluded that it was safer for both mother and baby to proceed with cesarean delivery and splenectomy in the early pre-term period. This patient’s pancytopenia improved within hours of spleen removal and has remained stable to date in outpatient follow-up. Baby Boy completed a NICU course of 22 days after requiring surfactant and respiratory support due to prematurity as well as monitoring due to maternal splenomegaly and thrombocytopenia. Conclusion This case offers valuable insights into managing patients with idiopathic splenomegaly during pregnancy and underscores the need for further investigation. Establishing clear delivery indications for these patients remains crucial, and prospective studies should evaluate the long-term impacts on both mother and child following combined splenectomy and cesarean delivery in the context of pancytopenia.

Polyethylene glycol (PEG)-modified (PEGylated) cationic liposomes are frequently used as delivery vehicles for small interfering RNA (siRNA)-based drugs because of their ability to encapsulate/complex with siRNA and prolong the circulation half-life in vivo. Nevertheless, we have reported that subsequent intravenous (IV) injections of siRNA complexed with PEGylated cationic liposomes (PLpx) induces the production of anti-PEG immunoglobulin M (IgM), which accelerates the blood clearance of subsequent doses of PLpx and other PEGylated products. In this study, it is interesting that splenectomy (removal of spleen) did not prevent anti-PEG IgM induction by IV injection of PLpx. This indicates that B cells other than the splenic version are involved in anti-PEG IgM production under these conditions. In vitro and in vivo studies have shown that peritoneal cells also secrete anti-PEG IgM in response to the administration of PLpx. Interleukin-6 (IL-6) is a glycoprotein that is secreted by peritoneal immune cells and has been detected in response to the in vivo administration of PLpx. These observations indicate that IV injection of PLpx stimulates the proliferation/differentiation of peritoneal PEG-specific B cells into plasma cells via IL-6 induction, which results in the production of anti-PEG IgM from the peritoneal cavity of mice. Our results suggest the mutual contribution of peritoneal B cells as a potent anti-PEG immune response against PLpx.

Dysbiosis of gut microbiota is frequent in liver cirrhosis (LC) patients, and splenectomy (SP) has been reported to improve LC. Herein, we report the effects of SP on gut microbiota, especially on Veillonella parvula, a Gram-negative coccus of the gastrointestinal tract, in LC mice, and the underlying mechanism. LC mice models were induced by tail vein injection of concanavalin A (ConA), followed by SP. 16s rRNA sequencing was conducted to analyze the effects of ConA induction and SP on mouse gut microbiota and the gene expression affected by gut microbiota. LC mice receiving SP were gavaged with Veillonella parvula. Likewise, hepatic stellate cells (HSC) and hepatocytes (HC) were induced with conditioned medium (CM) of Veillonella parvula. SP alleviated LC in mice by restoring gut barrier function and maintaining gut microbiota balance, with Veillonella as the key genus. The Veillonella parvula gavage on LC mice reversed the ameliorative effect of SP. The CM of Veillonella parvula promoted the activation of HSC and the release of IL-6, IL-1β, and TNF-α. Also, the CM of Veillonella parvula induced HC pyroptosis and the release of ALT and AST. Veillonella parvula represented an imbalance in the gut microbiota, thus enhancing gut-derived endotoxins in the liver with the main target being Tlr4/Nlrp3. Inhibition of Tlr4 blocked Veillonella parvula-induced HC damage, HSC activation, and subsequent LC progression. SP-mediated gut microbiota regulation ameliorates ConA-related LC progression by inhibiting Tlr4/Nlrp3 in the liver.

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a platelet count of less than 100 x 109 /L, resulting from antibody-mediated platelet destruction. Treatment for ITP typically involves steroids, and intravenous immunoglobulins (IVIG) can be added. Splenectomy is performed in cases with refractory ITP. Rituximab can suppress immunity but has limited efficacy in ITP cases. Herein, we present a rare case of a 30-year-old female who was first diagnosed with ITP and underwent a splenectomy two years later. However, seven years after surgery, she was presented with symptoms of ITP. A splenic scan showed an accessory spleen in the spleen bed, for which she underwent accessory spleen removal surgery. Her laboratory tests three days post-operation showed a rise in platelet count and hence was discharged a few days later. The patient had recurrent attacks of ITP even after the removal of the normal and accessory spleen, suggesting that accessory spleen removal may not always be an effective treatment for ITP. The patient eventually died. While splenectomy is a common treatment for ITP, it may not always be effective in all cases, and other treatments such as bone marrow transplantation may be necessary.

Circulating microparticles (MP) are being described as potential biomarkers for disease activity in a variety of conditions including sickle cell anemia (SCA). However, relatively little is known about the influence of spleen status on MP levels in patients with SCA. Using a prospective study design we characterize circulating MP in 144 patients with SCA in steady state by assessing their cellular origin and their relationships to spleen status defined by clinical and imaging findings. In addition, MP levels were studied according to demographic characteristics, clinical status, treatment modalities, and other hematological and biochemical parameters. Absolute plasma concentrations of MP were determined by flow cytometry. Patients with SCA displayed a 10-fold increase in levels of MP derived from red blood cell (RBC) and platelets (PLT) when compared to their healthy counterparts (p < 0.0001). Splenectomized patients with SCA have more pronounced levels of MPRBC and MPPLT, and remained elevated after several weeks of follow-up. Levels of MP were not significantly associated with spleen removal procedures, age, gender, clinical severity score, hydroxyurea therapy, hemoglobin F, and co-existence of glucose-6-phosphate dehydrogenase deficiency. Collectively, these results suggest that splenectomy affects circulating levels of MP regardless of the known SCA modifiers and correlates.

Splenosis is a harmless condition after a splenic injury or a spleen removal. It is heterotopic autotransplantation of splenic tissue seen inside the abdominal and pelvic holes. On imaging, various conditions can be differential diagnosis with splenosis, including metastatic infection, peritoneal carcinoma, peritoneal mesothelioma, stomach lymphoma, renal disease, hepatic adenomas, or endometriosis, dependent on its transmission. This review aims to increase public knowledge of this condition to avoid needless biopsies, surgeries, or treatments. Methods: We searched the PubMed and Scopus databases for relevant literature from 2002 through 2022 using the Medical Subject Headings Splenosis, Radiological, and Radionuclide diagnostic tools. In total, Thirty-five cases of splenosis were identified and reviewed. Conclusion: Splenosis should always be considered a differential diagnosis for soft tissue nodules in the abdomen and pelvis in patients with splenic surgery or trauma, especially without systemic symptoms. The literature documented only a few examples of splenosis, along with the radiologic features of these lesions. We review instances of splenosis identified by Scintigraphy, magnetic resonance imaging, computed tomography, and ultrasound. Our research expects this review to be considered a unique to compare the diagnosis made by radiologic and Radionuclide testing without any other form of treatment.

Introduction. Currently, the most successful option for treating benign hematological diseases of the spleen in children is splenectomy. Material and methods. In the article, the authors present their 25-year clinical experience in performing laparoscopic splenectomy in children with various diseases of the spleen. They discuss different techniques for surgical treatment of spleen diseases, features of preoperative preparation, current literature data. Results. The accumulated experience in laparoscopic surgeries for spleen removal, application of modern electrosurgical equipment and instruments for extracting tissues from the abdominal cavity have significantly reduced surgical time, improved cosmetic outcomes and quality of life of patients in the postoperative period. Somatostatin, prescribed right before the surgery and at the early postoperative period, prevents development of pancreatitis and erosive bleeding from the stump of the spleen pedicle in the vast majority of patients. Conclusion. The obtained catamnestic data demonstrate that laparoscopic surgery for spleen removal has its advantages. It is a safe, little-traumatic, effective and cosmetically good option for surgical spleen management in children.

Polatuzumab-bendamustine-rituximab as bridge to CD19-directed CAR T cells in mantle cell lymphoma refractory to ibrutinib and venetoclax.

Aspirin Administration Mitigates Platelet Hyperaggregability After Splenectomy in a Murine Model

Background: This study aimed to review our 25-year experience with pediatric laparoscopic splenectomy (LS) and describe tips, tricks, and technical considerations. Methods: The records of 121 children, undergoing minimally invasive splenectomy in the last 25 years (1996-2021), were retrospectively reviewed. Median patient age was 10.2 years (range 7-17). The patients were grouped according to the period: G1 (1996-2005) included 31 patients undergoing open splenectomy using left subcostal minilaparotomy (G1a) and 28 receiving LS using supine position (G1b); G2 (2006-2021) included 62 patients undergoing LS using lateral decubitus. A five-trocar technique was adopted in G1b, with the spleen removed through a Pfannenstiel incision. In G2, we preferred to use lateral decubitus, 10-mm 30° optic, only four trocars, and sealing devices. In such cases, the spleen was placed in an endobag, finger-fragmented, and extracted through the umbilicus. Furthermore, indocyanine green (ICG) fluorescence was used in the last 4 G2 patients to clearly identify the vascular anatomy. Results: The median operative time was 65 minutes in G1a, 125 in G1b, and 95 in G2. Complications occurred intraoperatively in 14 cases (11.5%): 5 bleedings during dissection (G1b), 4 endobag breakages during spleen removal (G2); 3 spleen capsule breakages during removal (G1a); and 2 instrumentation failures (G2). No conversions to open occurred. Median hospital stay was 6 days in G1a and 4 days in G1b and G2. Conclusions: LS is a standardized and effective procedure in children and is preferable to mini- or conventional open splenectomy. Our 25-year experience showed that major complications may occur even in expert hands, mainly during hilar dissection or spleen extraction. Technically, sealing devices and ICG fluorescence were helpful to perform a safer and faster procedure. We believe that lateral decubitus and 30° optic should be considered technical key points to provide excellent organ exposure and easier dissection of hilar structures.

Abstract. Splenectomy (SE) in hematologic patients is accompanied by an increased risk due to the presence of a hemostasis violation in most cases. All this determines the search for more favorable methods of surgical intervention in patients with diseases of the blood system. The purpose of the study is to improve the results of surgical treatment of patients with blood system diseases by planning the method of splenectomy.&#x0D; Materials and methods: the work was performed on the basis of a comprehensive clinical-laboratory and instrumental examination of 112 patients with various diseases of the blood system that needed surgical treatment. In addition to laboratory diagnosis, special attention was given to the anamnesis: duration of the disease, hormonal therapy; instrumental research methods: ultrasound of the abdominal cavity and CT, as well as nosologies. A harmonic scalpel was used to mobilize the spleen. The EndoGIA-30 stapler (AutoSuture) was used to treat the vascular pedicle.&#x0D; Results and discussion: analysis of the results of SE in patients with hematological profile showed that the choice of surgical access depends on many factors which can be set before operation by dint of ultrasound and CT. There were no conversion cases, which could be explained by the possibility of objective preoperative planning, as a result of which in cases of laparoscopic adverse events, a decision was made to perform open type of SE. The absence of complications and fatal cases at SE in hematologic patients shows the efficacy of the use of harmonic scalpel and EndoGIA-30 (AutoSuture) staplers to mobilize the spleen.&#x0D; Conclusions: the use of ultrasound and CT plays an important role in planning the method of spleenectomy, which avoids cases of conversion. Simultaneous use of harmonic scalpel and Autosuture staplers for performing SE helps to avoid complications.