Тотальная спленэктомия

Spherocytosis is a hemolytic disorder with marked heterogeneity of clinical features, ranging from asymptomatic conditions to fulminant hemolytic anemias. Laparoscopic splenectomy is a feasible and safe technique in the hands of skilled laparoscopic surgeons. The special characteristics of the spleen, that may pose a number of technical difficulties (patient position, organ mobilization and retrieval) are explained in this video, permitting the advantages of laparoscopic surgery to become available to patients with spherocytosis that need splenectomy.

In this key lecture, Professor Antonio D'Urso outlines the basic principles of laparoscopic splenectomy using a range of specific instruments suited for different technical cases. The main principles for accessory and large spleen management are demonstrated including a brief description of stepwise dissection maneuvers along with complications. Professor D'Urso also gave an overview of robotic splenectomy.

The description of the laparoscopic partial splenectomy in children covers all aspects of the surgical procedure used for the management of primarily benign tumoral pathologies and cases of hypersplenism.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: exploration, exposure, dissection, ligation, transection of parenchyma, end of procedure.
Consequently, this operating technique is well standardized for the management of this condition.

In this key lecture extracted from the IRCAD advanced course "laparoscopy in newborns, infants and children" (March 14-16, 2019), Dr. Becmeur demonstrates the strategy used to perform partial splenectomies in children.

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.