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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
1868 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 distal pancreatectomy with spleen resection
We reported a laparoscopic distal pancreatectomy with spleen resection for a mucinous cystic lesion. Four ports were positioned. The greater omentum was retracted to the superior part of the abdomen in order to detach the colon from the omentum and approach the lesser sac. The stomach was dissected. A tape was placed around the stomach through the abdominal wall, making it possible to retract the stomach at the level of the pyloric junction towards the upper part of the abdomen. A second tape was placed at the antral part in order to achieve a retraction towards the left hypochondrium at the superior part of the abdomen. The mesentericoportal axis was identified and dissected at the inferior border of the pancreas. The right gastroepiploic vein was one of the landmarks. The superior border of the pancreas was dissected in order to identify the splenic artery and a tape was positioned around it. The dissection was performed progressively at the anterior aspect of the mesentericoportal axis through an avascular channel. A tape was subsequently positioned around the pancreatic isthmus. The pancreas was divided with a stapler. The stapling was performed very progressively to avoid crushing the pancreas. The splenic vein was dissected in order to preserve the left gastric vein and a tape was positioned around it. The splenic artery was first divided between two clips on the remaining surface. The splenic vein was also divided. Dissection was pursued from the right to the left, making it possible to mobilize the pancreas. The inferior mesenteric vein was dissected and divided. Dissection of the posterior mesogastrium was initiated, making it possible to mobilize the splenopancreatic block. The dissection was performed anteriorly to the plane of Gerota’s fascia, anteriorly to the kidney. Since the posterior dissection was almost complete, our attention was turned to the superior part to complete the dissection of lesser sac adhesions at the superior border of the pancreas. It was necessary to divide the greater omentum by gradually dividing the short gastric vessels. Due to venous derivations linked to segmental portal hypertension, this dissection was performed through the application of the Endo GIA™ linear stapler. Since the entire specimen had been divided and freed, it was placed in a bag to be extracted through a suprapubic Pfannenstiel’s incision.
P Pessaux, X Untereiner, Z Cherkaoui, V Louis, D Mutter, J Marescaux
Surgical intervention
1 year ago
5441 views
605 likes
0 comments
45:34
Laparoscopic distal pancreatectomy with spleen resection
We reported a laparoscopic distal pancreatectomy with spleen resection for a mucinous cystic lesion. Four ports were positioned. The greater omentum was retracted to the superior part of the abdomen in order to detach the colon from the omentum and approach the lesser sac. The stomach was dissected. A tape was placed around the stomach through the abdominal wall, making it possible to retract the stomach at the level of the pyloric junction towards the upper part of the abdomen. A second tape was placed at the antral part in order to achieve a retraction towards the left hypochondrium at the superior part of the abdomen. The mesentericoportal axis was identified and dissected at the inferior border of the pancreas. The right gastroepiploic vein was one of the landmarks. The superior border of the pancreas was dissected in order to identify the splenic artery and a tape was positioned around it. The dissection was performed progressively at the anterior aspect of the mesentericoportal axis through an avascular channel. A tape was subsequently positioned around the pancreatic isthmus. The pancreas was divided with a stapler. The stapling was performed very progressively to avoid crushing the pancreas. The splenic vein was dissected in order to preserve the left gastric vein and a tape was positioned around it. The splenic artery was first divided between two clips on the remaining surface. The splenic vein was also divided. Dissection was pursued from the right to the left, making it possible to mobilize the pancreas. The inferior mesenteric vein was dissected and divided. Dissection of the posterior mesogastrium was initiated, making it possible to mobilize the splenopancreatic block. The dissection was performed anteriorly to the plane of Gerota’s fascia, anteriorly to the kidney. Since the posterior dissection was almost complete, our attention was turned to the superior part to complete the dissection of lesser sac adhesions at the superior border of the pancreas. It was necessary to divide the greater omentum by gradually dividing the short gastric vessels. Due to venous derivations linked to segmental portal hypertension, this dissection was performed through the application of the Endo GIA™ linear stapler. Since the entire specimen had been divided and freed, it was placed in a bag to be extracted through a suprapubic Pfannenstiel’s incision.
Spleen and splenic vessel preserving distal pancreatectomy for bifocal PNET in a young patient with MEN1
In this key lecture, Dr. Conrad outlines key steps related to spleen and splenic vessel preserving distal pancreatectomy, laparoscopic insulinoma enucleation of the posterior pancreatic neck, and laparoscopic partial splenectomy. He stresses the technical aspects of intraoperative ultrasonography, celiac trunk dissection, and gives some recommendations with regards to leak reduction, vascular dissection, and energy device use. He provides tips and tricks for insulinoma dissection and emphasizes key concepts and technical points for main pancreatic duct preservation, hilum dissection, and spleen transection.
C Conrad
Lecture
2 years ago
976 views
67 likes
0 comments
15:24
Spleen and splenic vessel preserving distal pancreatectomy for bifocal PNET in a young patient with MEN1
In this key lecture, Dr. Conrad outlines key steps related to spleen and splenic vessel preserving distal pancreatectomy, laparoscopic insulinoma enucleation of the posterior pancreatic neck, and laparoscopic partial splenectomy. He stresses the technical aspects of intraoperative ultrasonography, celiac trunk dissection, and gives some recommendations with regards to leak reduction, vascular dissection, and energy device use. He provides tips and tricks for insulinoma dissection and emphasizes key concepts and technical points for main pancreatic duct preservation, hilum dissection, and spleen transection.
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
1355 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 distal pancreatectomy with spleen preservation
Distal pancreatectomy is the standard curative treatment for symptomatic benign, premalignant, and malignant disease of the pancreatic body and tail. Nowadays, more than 80% of distal pancreatectomies are performed laparoscopically. The basic advantages of this approach over the open approach are the following: reduced blood loss, fewer complications, and shorter hospital stay. Pancreatic neoplasms, chronic pancreatitis, and pancreatic cysts are the main indications for laparoscopic distal pancreatectomy. Distal pancreatosplenectomy and spleen-preserving pancreatectomy are contraindicated in metastatic diseases, peritoneal carcinosis, vascular invasion, and pancreatitis involving the entire pancreas. Spleen-preserving distal pancreatectomy should be attempted in case of benign disease. Spleen preservation should preferably be achieved by preserving the splenic vessels (Kimura technique), but also by resecting the splenic vessels and maintaining vascularity through the short gastric vessels and the left gastroepiploic artery (Warshaw’s technique).
AM Cury
Lecture
3 years ago
2030 views
74 likes
0 comments
11:42
Laparoscopic distal pancreatectomy with spleen preservation
Distal pancreatectomy is the standard curative treatment for symptomatic benign, premalignant, and malignant disease of the pancreatic body and tail. Nowadays, more than 80% of distal pancreatectomies are performed laparoscopically. The basic advantages of this approach over the open approach are the following: reduced blood loss, fewer complications, and shorter hospital stay. Pancreatic neoplasms, chronic pancreatitis, and pancreatic cysts are the main indications for laparoscopic distal pancreatectomy. Distal pancreatosplenectomy and spleen-preserving pancreatectomy are contraindicated in metastatic diseases, peritoneal carcinosis, vascular invasion, and pancreatitis involving the entire pancreas. Spleen-preserving distal pancreatectomy should be attempted in case of benign disease. Spleen preservation should preferably be achieved by preserving the splenic vessels (Kimura technique), but also by resecting the splenic vessels and maintaining vascularity through the short gastric vessels and the left gastroepiploic artery (Warshaw’s technique).
Insulinoma of the pancreatic tail: left pancreatic resection with preservation of the spleen
This video shows a left pancreatic resection with splenic preservation in a 56-year-old woman. The patient has a visible insulinoma (1cm in diameter) located at the lower border of the pancreatic tail. The pancreatic tail is 3 to 4cm distant to the splenic hilum, which facilitates the dissection. Trocar position is similar to the one used in gastric laparoscopic surgery. First, the gastrocolic ligament is divided, and the stomach is retracted to the right side of the patient, along with the left lobe of the liver. After dissection of retrogastric adhesions, the peritoneum is incised on the lower border of the pancreas to get access to the retropancreatic area. The splenic artery is dissected on the upper pancreatic border and encircled with a vessel loop. The last retropancreatic attachments are taken down and the splenic vein is dissected and encircled with a vessel loop. Once the splenic vessels are retracted, the pancreatic transection is performed with a linear stapler. The last adhesions from the pancreatic tail to the splenic vessels are dissected with the LigaSure™ vessel-sealing device, making sure to preserve the splenic vessels. Finally, the resected pancreatic tail is placed in a specimen retrieval bag (Endobag®) and extracted through the trocar incision in the upper left abdomen. Hemostasis is checked while making sure that splenic perfusion is adequate.
P Vorwald, A Celdrán, M Posada, G Salcedo, T Georgiev, ML Sánchez de Molina, R Restrepo, S Ayora González
Surgical intervention
4 years ago
1824 views
44 likes
0 comments
10:03
Insulinoma of the pancreatic tail: left pancreatic resection with preservation of the spleen
This video shows a left pancreatic resection with splenic preservation in a 56-year-old woman. The patient has a visible insulinoma (1cm in diameter) located at the lower border of the pancreatic tail. The pancreatic tail is 3 to 4cm distant to the splenic hilum, which facilitates the dissection. Trocar position is similar to the one used in gastric laparoscopic surgery. First, the gastrocolic ligament is divided, and the stomach is retracted to the right side of the patient, along with the left lobe of the liver. After dissection of retrogastric adhesions, the peritoneum is incised on the lower border of the pancreas to get access to the retropancreatic area. The splenic artery is dissected on the upper pancreatic border and encircled with a vessel loop. The last retropancreatic attachments are taken down and the splenic vein is dissected and encircled with a vessel loop. Once the splenic vessels are retracted, the pancreatic transection is performed with a linear stapler. The last adhesions from the pancreatic tail to the splenic vessels are dissected with the LigaSure™ vessel-sealing device, making sure to preserve the splenic vessels. Finally, the resected pancreatic tail is placed in a specimen retrieval bag (Endobag®) and extracted through the trocar incision in the upper left abdomen. Hemostasis is checked while making sure that splenic perfusion is adequate.
Laparoscopic spleen-preserving distal pancreatectomy for mucinous cystadenoma (Warshaw’s technique)
The video presents the case of a surgical procedure performed in a 58-year old woman presenting with mucinous cystadenoma in the left pancreas. The patient complained of early satiety and her CT-scan demonstrated the existence of a huge cystic tumor replacing her pancreatic body and tail. The tumor involved the splenic vein and artery, resulting in a left segmental portal hypertension. Preoperative CT-scan showed that collaterals from the short gastric vessels maintained splenic vascularization.
A spleen-preserving distal pancreatectomy, sacrificing splenic vessels, according to Warshaw’s technique was decided upon.
Fa Madureira, Fe Madureira, D Madureira
Surgical intervention
5 years ago
3113 views
52 likes
0 comments
10:43
Laparoscopic spleen-preserving distal pancreatectomy for mucinous cystadenoma (Warshaw’s technique)
The video presents the case of a surgical procedure performed in a 58-year old woman presenting with mucinous cystadenoma in the left pancreas. The patient complained of early satiety and her CT-scan demonstrated the existence of a huge cystic tumor replacing her pancreatic body and tail. The tumor involved the splenic vein and artery, resulting in a left segmental portal hypertension. Preoperative CT-scan showed that collaterals from the short gastric vessels maintained splenic vascularization.
A spleen-preserving distal pancreatectomy, sacrificing splenic vessels, according to Warshaw’s technique was decided upon.
Laparoscopic left pancreatectomy with spleen preservation for multiple neuroendocrine tumors
Insulinoma is the most common functional neuroendocrine tumor of the pancreas. Most insulinomas are benign and solitary. Surgical resection is preferred for insulinomas and cure is achieved in more than 90% of the patients. Successful surgery requires accurate localization based on contrast enhanced CT-scan, PET-scan, and intraoperative ultrasound. This video shows a laparoscopic left pancreatectomy in a young patient presenting with typical symptoms evocative of Whipple's triad. Preoperative imaging studies identified two pancreatic tumors. Laparoscopic exploration and ultrasound identified four distinct tumors, all of them expressing somatostatin and insulin. This clinical case highlights the necessity and value of ultrasound exploration during surgery for neuroendocrine tumors.
B Dallemagne, D Mutter, L Soler, J Marescaux
Surgical intervention
6 years ago
2701 views
76 likes
0 comments
35:52
Laparoscopic left pancreatectomy with spleen preservation for multiple neuroendocrine tumors
Insulinoma is the most common functional neuroendocrine tumor of the pancreas. Most insulinomas are benign and solitary. Surgical resection is preferred for insulinomas and cure is achieved in more than 90% of the patients. Successful surgery requires accurate localization based on contrast enhanced CT-scan, PET-scan, and intraoperative ultrasound. This video shows a laparoscopic left pancreatectomy in a young patient presenting with typical symptoms evocative of Whipple's triad. Preoperative imaging studies identified two pancreatic tumors. Laparoscopic exploration and ultrasound identified four distinct tumors, all of them expressing somatostatin and insulin. This clinical case highlights the necessity and value of ultrasound exploration during surgery for neuroendocrine tumors.
Laparoscopic left pancreatectomy with spleen preservation for a suspicion of IPMN
Laparoscopic distal pancreatectomy is suitable for benign and premalignant neoplasms located in the body and tail of the pancreas. Spleen preservation following distal pancreatectomy is known to be safe. There are two distinct approaches to preserve the spleen during the dissection of the distal pancreas. The classic design is to identify, isolate, and preserve the splenic artery and vein. Alternatively, the splenic artery and vein are ligated with the pancreas, and perfusion of the spleen is assured by the short gastric vessels. Both are accepted as appropriate techniques to address a mass in the tail of the pancreas. This video demonstrates a left pancreatic resection with spleen preservation and ligation of the splenic artery and vein.
B Dallemagne, S Perretta, L Soler, J Marescaux
Surgical intervention
9 years ago
1042 views
48 likes
0 comments
19:27
Laparoscopic left pancreatectomy with spleen preservation for a suspicion of IPMN
Laparoscopic distal pancreatectomy is suitable for benign and premalignant neoplasms located in the body and tail of the pancreas. Spleen preservation following distal pancreatectomy is known to be safe. There are two distinct approaches to preserve the spleen during the dissection of the distal pancreas. The classic design is to identify, isolate, and preserve the splenic artery and vein. Alternatively, the splenic artery and vein are ligated with the pancreas, and perfusion of the spleen is assured by the short gastric vessels. Both are accepted as appropriate techniques to address a mass in the tail of the pancreas. This video demonstrates a left pancreatic resection with spleen preservation and ligation of the splenic artery and vein.
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
853 views
7 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 distal pancreatectomy with spleen and vessel preservation
This is the case of a female patient presenting with a 12mm endocrine tumor located at the pancreatic isthmus. To manage this case, a distal pancreatectomy is decided upon. This tumor measures 16mm in its transverse diameter and it is located just above the portal vein. The CT-scan and its 3D reconstruction helps us to plan the surgical intervention. The whole pancreas along with the splenic vessels (splenic vein and artery) are reconstructed. The objective is to precisely locate the tumor in order to determine the resection modalities. A distal pancreatectomy with preservation of the splenic vessels is therefore decided upon.
D Mutter, L Soler, J Marescaux
Surgical intervention
9 years ago
1804 views
163 likes
0 comments
17:42
Laparoscopic distal pancreatectomy with spleen and vessel preservation
This is the case of a female patient presenting with a 12mm endocrine tumor located at the pancreatic isthmus. To manage this case, a distal pancreatectomy is decided upon. This tumor measures 16mm in its transverse diameter and it is located just above the portal vein. The CT-scan and its 3D reconstruction helps us to plan the surgical intervention. The whole pancreas along with the splenic vessels (splenic vein and artery) are reconstructed. The objective is to precisely locate the tumor in order to determine the resection modalities. A distal pancreatectomy with preservation of the splenic vessels is therefore decided upon.
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
3189 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
892 views
31 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.
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
1448 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
4684 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.
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
7084 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
2530 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.