We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.
Filter by
Specialty
View more
Technologies
View more
Clear filter Media type
View more
Clear filter Category
View more
Publication date
Sort by:
Subtotal laparoscopic splenectomy for hemolytic disorders in a 5-year-old girl
In case of hemolytic disease, subtotal splenectomy is an alternative to total splenectomy, the efficacy of which has been evidenced in the literature (Inter J Surg 2010;8:48-51). This procedure is particularly relevant in young children as it precludes risks of infection related to total splenectomy. Subtotal splenectomy should reduce the size of the splenic parenchyma by 80% in order to prevent recurrence and completion surgery in the short term. In 2008, we had already reported a first multicentric study on subtotal splenectomy (Surg Endosc 2008;22:45-9).
Technically, it is interesting to have access to an inconstant artery draining the superior pole of the spleen, which is then left in place (Surg Endosc 2006;21:1678). When this artery is not present, the superior pole of the spleen will be preserved as it is vascularized by one or two short vessels of the gastrosplenic omentum.
F Becmeur, C Klipfel, A Lachkar
Surgical intervention
4 months ago
986 views
8 likes
0 comments
04:19
Subtotal laparoscopic splenectomy for hemolytic disorders in a 5-year-old girl
In case of hemolytic disease, subtotal splenectomy is an alternative to total splenectomy, the efficacy of which has been evidenced in the literature (Inter J Surg 2010;8:48-51). This procedure is particularly relevant in young children as it precludes risks of infection related to total splenectomy. Subtotal splenectomy should reduce the size of the splenic parenchyma by 80% in order to prevent recurrence and completion surgery in the short term. In 2008, we had already reported a first multicentric study on subtotal splenectomy (Surg Endosc 2008;22:45-9).
Technically, it is interesting to have access to an inconstant artery draining the superior pole of the spleen, which is then left in place (Surg Endosc 2006;21:1678). When this artery is not present, the superior pole of the spleen will be preserved as it is vascularized by one or two short vessels of the gastrosplenic omentum.
Laparoscopic partial splenectomy
A 39-year-old male patient was referred to our institution for a total laparoscopic splenectomy. The patient presented a CT-scan with a heterogeneous lesion in the lower aspect of the spleen. Two different hematologists-oncologists recommended a total splenectomy due the characteristics of the lesion. We discussed this recommendation during the oncological committee at our institution and due to the anatomical variation of the splenic artery and the absence of characterization of the lesion as 100% malignant, a laparoscopic partial splenectomy was decided upon with an intraoperative frozen analysis to determine if any further resection would be necessary. In this video, the authors present the technical aspects of a complex surgical resection.
D Awruch, M Grimoldi, M Blanco, R Sanchez Almeyra
Surgical intervention
2 years ago
3269 views
179 likes
0 comments
05:28
Laparoscopic partial splenectomy
A 39-year-old male patient was referred to our institution for a total laparoscopic splenectomy. The patient presented a CT-scan with a heterogeneous lesion in the lower aspect of the spleen. Two different hematologists-oncologists recommended a total splenectomy due the characteristics of the lesion. We discussed this recommendation during the oncological committee at our institution and due to the anatomical variation of the splenic artery and the absence of characterization of the lesion as 100% malignant, a laparoscopic partial splenectomy was decided upon with an intraoperative frozen analysis to determine if any further resection would be necessary. In this video, the authors present the technical aspects of a complex surgical resection.
Subtotal cystectomy with laparoscopic splenic preservation
Non-parasitic splenic lesions are a rare entity. Since they can generate signs and abdominal symptoms and cause many complications, their detection requires some form of treatment. The possibility of post-splenectomy fatal sepsis has led to the search for new therapeutic alternatives which simultaneously ensure the healing process and preserve the splenic tissue. The preservation of at least 25% of splenic tissue provides protection against pneumococcal bacteremia. One of the techniques used is partial cyst decapsulation with splenic preservation.
We report the case of a 17-year-old woman who was incidentally diagnosed with a 4cm splenic cystic with negative serological studies and tumor markers suggestive of an epidermal cyst. Radiological monitoring of the lesion is performed and a cystic growth of 7cm is observed. As a result, surgery is decided upon.
At laparoscopy, a splenic cyst of 7cm in diameter is found. However, it does not affect the splenic vessels. Lancing and draining the cyst is made and partial cyst decapsulation is performed with splenic preservation. The patient made an uneventful recovery.
Partial decapsulation of the cyst’s wall offers several advantages: it is technically easier to perform, involves minimal blood loss, it preserves the entire splenic tissue and has a high cure rate. It is an excellent therapeutic alternative for young people with splenic cysts because it eliminates the disease process without loss of splenic tissue and it is minimally invasive for the patient.
FE Viamontes Ugalde, A Abascal Amo, I García Sanz
Surgical intervention
2 years ago
900 views
30 likes
0 comments
09:32
Subtotal cystectomy with laparoscopic splenic preservation
Non-parasitic splenic lesions are a rare entity. Since they can generate signs and abdominal symptoms and cause many complications, their detection requires some form of treatment. The possibility of post-splenectomy fatal sepsis has led to the search for new therapeutic alternatives which simultaneously ensure the healing process and preserve the splenic tissue. The preservation of at least 25% of splenic tissue provides protection against pneumococcal bacteremia. One of the techniques used is partial cyst decapsulation with splenic preservation.
We report the case of a 17-year-old woman who was incidentally diagnosed with a 4cm splenic cystic with negative serological studies and tumor markers suggestive of an epidermal cyst. Radiological monitoring of the lesion is performed and a cystic growth of 7cm is observed. As a result, surgery is decided upon.
At laparoscopy, a splenic cyst of 7cm in diameter is found. However, it does not affect the splenic vessels. Lancing and draining the cyst is made and partial cyst decapsulation is performed with splenic preservation. The patient made an uneventful recovery.
Partial decapsulation of the cyst’s wall offers several advantages: it is technically easier to perform, involves minimal blood loss, it preserves the entire splenic tissue and has a high cure rate. It is an excellent therapeutic alternative for young people with splenic cysts because it eliminates the disease process without loss of splenic tissue and it is minimally invasive for the patient.
Robotic partial splenectomy for cystic lesion of the spleen
We report the case of a 21-year-old woman with a cystic lesion of the spleen treated with a robotic partial splenectomy. The patient is placed in a right lateral decubitus position. Four ports are introduced into the left hypochondrium. The robot is placed at the level of the patient’s left shoulder. The intervention is begun with a lowering of the splenic flexure. Dissection is initiated at the upper pole of the spleen by retracting the stomach and by progressively dividing the different short vessels. It is decided to start the parenchymotomy approximately 1cm from the devascularized area. Transection is begun using an ultrasonic dissector. Hemostasis is subsequently achieved progressively. Transection is completed by means of a firing of the Endo GIA™ linear stapler. Hemostasis is further completed using the Aquamantys® system and bipolar sealers. The specimen is fully mobilized and placed in a bag. It is extracted by means of a small suprapubic Pfannenstiel’s incision. Pathological findings demonstrate the presence of an epidermoid cyst. The postoperative outcome is uneventful. The patient is discharged on postoperative day 4.
P Pessaux, R Memeo, V De Blasi, N Ferreira, D Mutter, J Marescaux
Surgical intervention
3 years ago
1873 views
70 likes
0 comments
09:14
Robotic partial splenectomy for cystic lesion of the spleen
We report the case of a 21-year-old woman with a cystic lesion of the spleen treated with a robotic partial splenectomy. The patient is placed in a right lateral decubitus position. Four ports are introduced into the left hypochondrium. The robot is placed at the level of the patient’s left shoulder. The intervention is begun with a lowering of the splenic flexure. Dissection is initiated at the upper pole of the spleen by retracting the stomach and by progressively dividing the different short vessels. It is decided to start the parenchymotomy approximately 1cm from the devascularized area. Transection is begun using an ultrasonic dissector. Hemostasis is subsequently achieved progressively. Transection is completed by means of a firing of the Endo GIA™ linear stapler. Hemostasis is further completed using the Aquamantys® system and bipolar sealers. The specimen is fully mobilized and placed in a bag. It is extracted by means of a small suprapubic Pfannenstiel’s incision. Pathological findings demonstrate the presence of an epidermoid cyst. The postoperative outcome is uneventful. The patient is discharged on postoperative day 4.
Laparoscopic resection of a splenic artery aneurysm with splenic preservation
This video illustrates the laparoscopic resection of a splenic artery aneurysm with splenic preservation in a young lady.
The lesion was discovered fortuitously by ultrasound for an unrelated cause. Embolization was unsuccessful because of the inability of our interventional radiology team to reach the aneurysm itself for coiling.
It is thought that splenic artery aneurysms are present in 1% of the population (1), and coiling/resection is often advocated, especially in young women in childbearing age.
The aneurysm was isolated and its multiple feeding vessels clipped before complete resection. The spleen remained well vascularized through the short gastric vessels and was left in situ.
1. Ayalon A, Wiesner RH, Perkins JD, Tominaga S, Hayes DH, Krom RA. Splenic artery aneurysms in liver transplant patients. Transplantation 1988;45:386-9.
Y Bendavid, B Montreuil
Surgical intervention
3 years ago
1452 views
49 likes
0 comments
07:55
Laparoscopic resection of a splenic artery aneurysm with splenic preservation
This video illustrates the laparoscopic resection of a splenic artery aneurysm with splenic preservation in a young lady.
The lesion was discovered fortuitously by ultrasound for an unrelated cause. Embolization was unsuccessful because of the inability of our interventional radiology team to reach the aneurysm itself for coiling.
It is thought that splenic artery aneurysms are present in 1% of the population (1), and coiling/resection is often advocated, especially in young women in childbearing age.
The aneurysm was isolated and its multiple feeding vessels clipped before complete resection. The spleen remained well vascularized through the short gastric vessels and was left in situ.
1. Ayalon A, Wiesner RH, Perkins JD, Tominaga S, Hayes DH, Krom RA. Splenic artery aneurysms in liver transplant patients. Transplantation 1988;45:386-9.
Laparoscopic splenectomy
In this video, Professor Martin Walz provides an overview of laparoscopic splenectomy. Since the first laparoscopic splenectomy in 1991, the procedure has become increasingly precise. The main indications for laparoscopic splenectomy are hypersplenism, splenomegaly, and associated diseases. Splenomegaly (> 20-25cm or > 1,000g) is the main contraindication. Immunization is essential for splenectomy. The patient is either placed in a left decubitus position with a 45-degree rotation or in a right decubitus position with a 90-degree rotation. The main steps of laparoscopic splenectomy are briefly demonstrated in this video. Laparoscopic splenectomy is the gold standard in small tumors with lower blood loss, low morbidity and mortality with a shorter hospital stay.
M Walz
Lecture
3 years ago
4736 views
231 likes
2 comments
19:41
Laparoscopic splenectomy
In this video, Professor Martin Walz provides an overview of laparoscopic splenectomy. Since the first laparoscopic splenectomy in 1991, the procedure has become increasingly precise. The main indications for laparoscopic splenectomy are hypersplenism, splenomegaly, and associated diseases. Splenomegaly (> 20-25cm or > 1,000g) is the main contraindication. Immunization is essential for splenectomy. The patient is either placed in a left decubitus position with a 45-degree rotation or in a right decubitus position with a 90-degree rotation. The main steps of laparoscopic splenectomy are briefly demonstrated in this video. Laparoscopic splenectomy is the gold standard in small tumors with lower blood loss, low morbidity and mortality with a shorter hospital stay.
Robotic distal pancreatectomy with spleen preservation with splenic vascular resection (Warshaw's technique)
We report the case of a 39-year-old woman who underwent morphological examination (CT-scan and MRI) for poorly systematized abdominal pain, which demonstrated the presence of a unilocular macrocystic lesion at the tail of the pancreas. The diagnosis established reported a mucinous cystadenoma, and a robotic distal spleen-preserving pancreatectomy was decided upon.
The dissection is initiated at the inferior border of the pancreas. Dissection has been performed at the level of the splenic hilum with freeing of the pancreatic tail. The splenic branches of the splenic vein are identified at the posterior aspect of the pancreas. These branches are freed progressively. As a result, the distal part of the pancreas is freed from the splenic hilum, and dissection will be performed from left to right. This dissection was decided upon as the lesion is located very distally. The splenic vein and the splenic artery are freed at the level of the hilum. Dissection is continued progressively to the right.
Dissection of the cyst in relation to the splenic vein is uneasy as there are several inflammatory adhesions. Dissection is then performed at the isthmic part of the pancreas. The splenic artery is dissected at the superior border of the pancreas. Dissection is then carried out at the posterior aspect of the pancreas. Considering the presence of adhesions, the operative strategy is changed. It is decided to perform a distal pancreatectomy with preservation of the spleen without vessels preservation. However, the splenic vessels are divided. Consequently, the splenic artery is ligated by a clip and divided. The distal part of the splenic artery is also ligated. Proximally, the splenic vein is dissected and divided. The distal part has also been clipped.
The distal division of arterial and venous vessels is performed. The pancreas was divided at the level of its body. The specimen is placed into a bag and extracted by means of a small Pfannenstiel incision. At the end of the procedure, the spleen appears to be well-vascularized by short vessels. The CT-scan performed on postoperative day 5 demonstrates that the spleen is well-vascularized and rules out the presence of any collection in the place left by pancreatectomy. The postoperative outcome is uneventful. There is no pancreatic fistula. The patient is discharged on postoperative day 7. Pathological findings confirm the presence of a mucinous cystadenoma without any malignancy.
P Pessaux, J Hallet, R Memeo, JB Delhorme, D Mutter, J Marescaux
Surgical intervention
4 years ago
1366 views
28 likes
0 comments
12:38
Robotic distal pancreatectomy with spleen preservation with splenic vascular resection (Warshaw's technique)
We report the case of a 39-year-old woman who underwent morphological examination (CT-scan and MRI) for poorly systematized abdominal pain, which demonstrated the presence of a unilocular macrocystic lesion at the tail of the pancreas. The diagnosis established reported a mucinous cystadenoma, and a robotic distal spleen-preserving pancreatectomy was decided upon.
The dissection is initiated at the inferior border of the pancreas. Dissection has been performed at the level of the splenic hilum with freeing of the pancreatic tail. The splenic branches of the splenic vein are identified at the posterior aspect of the pancreas. These branches are freed progressively. As a result, the distal part of the pancreas is freed from the splenic hilum, and dissection will be performed from left to right. This dissection was decided upon as the lesion is located very distally. The splenic vein and the splenic artery are freed at the level of the hilum. Dissection is continued progressively to the right.
Dissection of the cyst in relation to the splenic vein is uneasy as there are several inflammatory adhesions. Dissection is then performed at the isthmic part of the pancreas. The splenic artery is dissected at the superior border of the pancreas. Dissection is then carried out at the posterior aspect of the pancreas. Considering the presence of adhesions, the operative strategy is changed. It is decided to perform a distal pancreatectomy with preservation of the spleen without vessels preservation. However, the splenic vessels are divided. Consequently, the splenic artery is ligated by a clip and divided. The distal part of the splenic artery is also ligated. Proximally, the splenic vein is dissected and divided. The distal part has also been clipped.
The distal division of arterial and venous vessels is performed. The pancreas was divided at the level of its body. The specimen is placed into a bag and extracted by means of a small Pfannenstiel incision. At the end of the procedure, the spleen appears to be well-vascularized by short vessels. The CT-scan performed on postoperative day 5 demonstrates that the spleen is well-vascularized and rules out the presence of any collection in the place left by pancreatectomy. The postoperative outcome is uneventful. There is no pancreatic fistula. The patient is discharged on postoperative day 7. Pathological findings confirm the presence of a mucinous cystadenoma without any malignancy.
Laparoscopic splenectomy in a patient with cirrhosis and splenomegaly
Introduction
The first laparoscopic splenectomy was initially described more than 20 years ago. Hypersplenism associated with thrombocytopenia in cirrhotic patients could compromise quality of life and also limit therapeutic options such as interferon treatment.
Material and methods
We present the case of a 48-year-old woman with a history of parenteral drug abuse, HCV/HIV co-infection, cirrhosis (Child-Pugh B). Treatment with interferon and antiretrovirals must be discontinued for severe thrombocytopenia. As a result, laparoscopic splenectomy stands out as a therapeutic measure.
Results
In this video, we present a laparoscopic splenectomy approach in a cirrhotic patient with splenomegaly and hypersplenism in order to initiate interferon and antiretroviral treatment. It is possible to note the presence of collateral circulation, cirrhotic liver, and moderate splenomegaly (final spleen weight of 735 grams).
Conclusions
Laparoscopic access proves safe and effective in cirrhotic patients in order to extend the therapeutic managements of their underlying diseases. It can also improve the Child-Pugh score.
C Rodríguez-Otero Luppi, EM Targarona Soler, C Balagué Ponz, JL Pallarés Segura, M Trías Folch
Surgical intervention
6 years ago
7104 views
131 likes
0 comments
08:01
Laparoscopic splenectomy in a patient with cirrhosis and splenomegaly
Introduction
The first laparoscopic splenectomy was initially described more than 20 years ago. Hypersplenism associated with thrombocytopenia in cirrhotic patients could compromise quality of life and also limit therapeutic options such as interferon treatment.
Material and methods
We present the case of a 48-year-old woman with a history of parenteral drug abuse, HCV/HIV co-infection, cirrhosis (Child-Pugh B). Treatment with interferon and antiretrovirals must be discontinued for severe thrombocytopenia. As a result, laparoscopic splenectomy stands out as a therapeutic measure.
Results
In this video, we present a laparoscopic splenectomy approach in a cirrhotic patient with splenomegaly and hypersplenism in order to initiate interferon and antiretroviral treatment. It is possible to note the presence of collateral circulation, cirrhotic liver, and moderate splenomegaly (final spleen weight of 735 grams).
Conclusions
Laparoscopic access proves safe and effective in cirrhotic patients in order to extend the therapeutic managements of their underlying diseases. It can also improve the Child-Pugh score.
SILS single port splenectomy in a woman diagnosed with idiopathic thrombocytopenia
Laparoscopic splenectomy (LS) has become the technique of choice for surgical removal of the spleen since its first description in 1991. Indications for LS have rapidly increased and LS is now considered the standard approach for the treatment of benign and malignant hematologic disorders, especially by young patients who find small scars cosmetically preferable.
Single incision laparoscopic surgery (SILS) is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery. In this video, we present an original technique of SILS splenectomy in a woman diagnosed with idiopathic thrombocytopenia. A 2.2cm left subcostal incision lateral to the rectus muscles was used for the placement of the single port device with conventional laparoscopic instruments, using a Veress needle covered by a small sponge to lift the spleen that was removed through the same incision.
F Corcione, F Pirozzi, F Galante
Surgical intervention
7 years ago
2533 views
38 likes
0 comments
05:51
SILS single port splenectomy in a woman diagnosed with idiopathic thrombocytopenia
Laparoscopic splenectomy (LS) has become the technique of choice for surgical removal of the spleen since its first description in 1991. Indications for LS have rapidly increased and LS is now considered the standard approach for the treatment of benign and malignant hematologic disorders, especially by young patients who find small scars cosmetically preferable.
Single incision laparoscopic surgery (SILS) is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery. In this video, we present an original technique of SILS splenectomy in a woman diagnosed with idiopathic thrombocytopenia. A 2.2cm left subcostal incision lateral to the rectus muscles was used for the placement of the single port device with conventional laparoscopic instruments, using a Veress needle covered by a small sponge to lift the spleen that was removed through the same incision.
Single incision laparoscopic partial splenectomy for splenic hemangioma
Laparoscopy is now considered the "gold standard" approach for splenectomy when treating different benign and malignant diseases requiring the removal of the whole or part of the spleen.
During the last few months in both experimental and clinical settings, new techniques such as natural orifice transluminal endoscopic surgery (NOTES™) and single incision laparoscopic surgery (SILS) or single port laparoscopic surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to carry out the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision partial splenectomy for the treatment of splenic hemangioma.
A 44-year-old woman complained with recurrent abdominal pain in the left hypochondrium and flank and was referred to our department.
Abdominal US as well as CT-scan images demonstrated the presence of a large cystic-like lesion at the lower pole of the spleen. It presented some septal division with the cyst. Blood tests were normal and all markers were negative.
Single incision partial splenectomy was performed with no complications and the patient’s postoperative course was uneventful.
L Boni, G Dionigi, M Di Giuseppe, E Colombo, L Giavarini, F Cantore, R Dionigi
Surgical intervention
9 years ago
1648 views
13 likes
0 comments
04:58
Single incision laparoscopic partial splenectomy for splenic hemangioma
Laparoscopy is now considered the "gold standard" approach for splenectomy when treating different benign and malignant diseases requiring the removal of the whole or part of the spleen.
During the last few months in both experimental and clinical settings, new techniques such as natural orifice transluminal endoscopic surgery (NOTES™) and single incision laparoscopic surgery (SILS) or single port laparoscopic surgery (SPLS) have been attempted in order to reduce even more the surgical trauma in laparo-endoscopic procedures.
SPLS allows to perform different surgical procedures using the umbilicus as the only site to access the abdominal cavity and, by using special trocars and instruments, to carry out the operation using the same techniques and principles of standard laparoscopic surgery.
The video describes our personal technique for totally single incision partial splenectomy for the treatment of splenic hemangioma.
A 44-year-old woman complained with recurrent abdominal pain in the left hypochondrium and flank and was referred to our department.
Abdominal US as well as CT-scan images demonstrated the presence of a large cystic-like lesion at the lower pole of the spleen. It presented some septal division with the cyst. Blood tests were normal and all markers were negative.
Single incision partial splenectomy was performed with no complications and the patient’s postoperative course was uneventful.