Distal Splenopancreatectomy |
199 |
This procedure is illustrated in Fig. 12.20. The first step of the splenectomy is the mobili- |
Distal |
zation of the inferior aspect of the spleen, dividing the phrenic attachments of the colon. |
Splenopan |
The next step is the mobilization of the phrenic attachment of the spleen. The superior |
createctomy |
aspect of the spleen is then separated from the diaphragm. Once this is done, the short |
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gastric vessels are taken down,exposing the pale tissue of the pancreatic tail.Alternatively, |
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this mobilization of the spleen can be performed after the control of the splenic vessels |
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and the division of the pancreatic tail. This has the advantage of keeping the spleen hang- |
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ing on the diaphragm. |
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Fig. 12.20 Distal splenopancreatectomy steps: 1 mobilization of the inferior splenic pole; 2 division of the splenohepatic ligament; 3 mobilization of the superior pole of the spleen; 4 control of the splenic vessels at the superior aspect of the pancreatic tail; 5 division of the pancreatic tail. Alternatively, 1, 2, 3 can be performed after 4 and 5
200 Chapter 12 Splenectomy (Total and Partial) and Splenopancreatectomy
Slowly and carefully, the splenic artery and vein are identified. Sometimes it is possible to dissect both en bloc, but in most cases the splenic artery and the splenic vein are divided separately. Using the right angle dissector, the vessels are identified, dissected out, and divided using clips; it is indeed safer to place large clips than use a vascular linear stapler. The pancreatectomy is then completed using one firing of the linear cutter, 45 blue with seamguard (WL Gore Flagstaf, AZ) (Fig. 12.21). Hemeostasis is rechecked and any bleeding site is sutured to minimize the risk of pancreatic leak. The specimen is placed in a bag and removed.
Fig. 12.21 Stapling of the pancreatic tail using a stapler with a blue cartridge and reinforcement with Seamguard
Selected Further Reading |
201 |
Beanes S, Emil S, Kosi M, Applebaum H, Atkinson J (1995) A comparison of laparoscopic versus open splenectomy in children. Am Surg 61(10):908–910
Brunt LM, Langer JC, Quasebarth MA, Whitman ED (1996) Comparative analysis of laparo scopic versus open splenectomy. Am J Surg 172(5):596–599
Cadiere GB,Verroken R, Himpens J, Bruyns J, Efira M, De Wit S (1994) Operative strategy in laparoscopic splenectomy. J Am Coil Surg 179(6):668–672
Danno K, Ikeda M, Sekimoto M, Sugimoto T, Takemasa I, Yamamoto H, Doki Y, Monden M, Mori M (2009) Diameter of splenic vein is a risk factor for portal or splenic vein thrombosis after laparoscopic splenectomy. Surgery 145(5):457–464
Delaitre B (1995) Laparoscopic splenectomy: the ‘hanged spleen’ technique. Surg Endosc 9:528–529
Diaz J, Eisenstat M, Chung R (1997) A case-controlled study of laparoscopic splenectomy. Am J Surg 173(4):348–350
Duperier T, Brody F, Felsher J, Walsh RM, Rosen M, Ponsky J (2004) Predictive factors for successful laparoscopic splenectomy in patients with immune thrombocytopenic purpura. Arch Surg 139(1):61–66
Flowers JL, Lefor AT, Steers J, Heyman M, Graham SM, Imbembo AL (1996) Laparoscopic splenectomy in patients with hematologic diseases. Ann Surg 224(1):19–28
Glasgow RE, Yee LF, Mulvihill SJ (1997) Laparoscopic splenectomy. The emerging standard. Surg Endosc 11(2):108–112
Grahn SW,Alvarez J III, Kirkwood K (2006) Trends in laparoscopic splenectomy for massive splenomegaly. Arch Surg 141(8):755–756
Hashizume M, Sugimachi K, Kitano S et al (1994) Laparoscopic splenectomy. Am J Surg 167(6):611–614
Kaiser A, Umbach T, Katkhouda N (2002) Predictors of outcome after laparoscopic splenectomy. Probl Gen Surg 19:95–101
Katkhouda N, Hurwitz M (1999) Laparoscopic splenectomy for hematologic disease.Adv Surg 33:141–161
Katkhouda N, Hurwitz MB, Rivera RT, Chandra M, Waldrep DJ, Gugenheim J, Mouiel J (1998) Laparoscopic splenectomy: outcome and efficacy in 103 consecutive patients. Ann Surg 228(4):568–578
Katkhouda N, Le Goff D, Tricarico A, Castillo L (1988) Hydatid cyst of the pancreas responsible for chronic recurrent pancreatitis. La Presse Médicale 38:2021–2024 (in French)
Katkhouda N, Manhas S, Umbach TW, Kaiser A (2001) Laparoscopic splenectomy. J Laparoendosc Surg 11:383–390
Katkhouda N, Mavor E (2000) Laparoscopic splenectomy. Surg Clin North Am 80: 1285–1297
Katkhouda N, Mouiel J (1986) Pancreatic cancer in mother and daughter. Lancet 8509(9):74
Katkhouda N, Tricarico A, Mouiel J (1988) Acute pancreatitis: the role of biliary millilithiasis. Urgentis Chirurgiae Commentaria 11:27–31 (in Italian)
Katkhouda N, Umbach T, Kaiser A (2002) Splenectomy: anterior laparoscopic approach. Probl Gen Surg 19:24–28
Katkhouda N, Waldrep D, Feinstein D, Soliman H, Stain S, Ortega A, Mouiel J (1996) Unresolved issues in laparoscopic splenectomy. Am J Surg 172:585–590
Liang MK, Marks JL (2007) Postsplenectomy portal, mesenteric, and splenic vein thrombosis. Arch Surg 142(6):575
Miles WF, Greig JD, Wilson RG, Nixon SJ (1996) Technique of laparoscopic splenectomy with a powered vascular linear stapler. Br J Surg 83(9):1212–1214
Mouiel J, Katkhouda N (1992) Endo-laparoscopic treatment of pancreatic cancer. Surg Laparosc Endosc 2:241–243
Selected
Further
Reading
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Chapter 12 |
Splenectomy (Total and Partial) and Splenopancreatectomy |
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Phillips EH, Carroll BJ, Fallas MJ (1994) Laparoscopic splenectomy. Surg Endosc |
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8(8):931–933 |
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Poulin EC, Thibault C (1995) Laparoscopic splenectomy for massive splenomegaly: oper- |
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ative technique and case report. Can J Surg 38(1):69–72 |
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Poulin BC, Thibault C, Mamazza J (1995) Laparoscopic splenectomy. Surg Endosc |
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9(2):172–176 |
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Rege RV, Merriam LT, Joehi RJ (1996) Laparoscopic splenectomy. Surg Clin N Am 76(3): |
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459–468 |
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Rhodes M, Rudd M, O’Rourke N, Nathanson L, Fielding G (1995) Laparoscopic splenec- |
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tomy and lymph node biopsy for hematologic disorders. Ann Surg 222(1):43–46 |
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Rothenberg |
SS (1996) Laparoscopic splenectomy using the harmonic scalpel. |
J Laparoendosc Surg 6(suppl 1):S61–S63.
Rudowski WJ (1995) Laparoscopic splenectomy. Am J Surg 169(2):282–283
Saldinger PF, Matthews JB, Mowschenson PM, Hodin RA (1996) Stapled laparoscopic sple nectomy: initial experience. J Am Coil Surg 182(5):459–461
Sampath S, Meneghetti AT, MacFarlane JK, Nguyen NH, Benny WB, Panton ON (2007) An 18-year review of open and laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Am J Surg 193(5):580–583
Schlinkert RT, Mann D (1995) Laparoscopic splenectomy offers advantages in selected patients with immune thrombocytopenic purpura. Am J Surg 170(6):624–626
Smith CD, Meyer TA, Goretsky MJ (1996) Laparoscopic splenectomy by the lateral approach: a safe and effective alternative to open splenectomy for hematologic diseases. Surgery 120(5):789–794
Trias M, Targarona EM, Balague C (1996) Laparoscopic splenectomy: an evolving technique. A comparison between anterior and lateral approaches. Surg Endosc 10(4):389–392
Uranus S, Pfeifer J, Schauer C et al (1995) Laparoscopic partial splenic resection. Surg Laparosc Endosc 5(2):133–136
Watson DI, Coventry BJ, Chin T, Gill PG, Malycha P (1997) Laparoscopic versus open splenectomy for immune thrombocytopenic purpura. Surgery 121(1):18–22
Yee LF, Carvajal SH, de Lorimier AA, Mulvihill ST (1995) Laparoscopic splenectomy. The initial experience at University of California, San Francisco. Arch Surg 130(8):874–877Incisional