Application of Laparoscopic Partial Splenectomy with Total Blood Flow Occlusion in Benign Splenic Lesions

Summary

In this study, we describe an intraoperative hemorrhage control technique for laparoscopic partial splenectomy, improving spleen resection's safety and precision.

Abstract

Laparoscopic partial splenectomy (LPS) is gradually becoming the preferred method for treating benign splenic lesions. However, due to the abundant blood supply and its soft, fragile tissue texture, especially when the lesion is located near the splenic hilum or is particularly large, performing partial splenectomy (PS) in clinical practice is extremely challenging. Therefore, we have been continuously exploring and optimizing hemorrhage control methods during PS, and we here propose a method to perform LPS with complete spleen blood flow occlusion.

This study describes an optimized approach to control intraoperative hemorrhage during LPS. First, it involves the thorough dissection of the splenic ligaments and careful separation of the pancreatic tail from the spleen. With complete exposure to the splenic hilum, we temporarily occlude the entire blood supply of the spleen using a laparoscopic bulldog clip. Subsequently, we employ intraoperative ultrasound to identify the boundary of the lesion and resect the corresponding portion of the spleen under complete blood flow control. This approach embodies the essence of 'spleen preservation' through effective hemorrhage control and precise resection. It is particularly suitable for laparoscopic surgery and deserves further clinical promotion.

Introduction

With a profound understanding of the physiological functions of the spleen, the research underscores its pivotal role in the body's immune response, hematopoiesis, and clearance of red blood cells¹. Complications following splenectomy, such as overwhelming post-splenectomy infections (OPSIs), pulmonary hypertension, and thromboembolism, significantly influence the choice of surgical methods in clinical practice^2,3. According to the literature, patients after total splenectomy exhibit a decreased capacity to clear malaria-parasitized RBCs and a higher risk of developing meningitis and se....

Protocol

This study follows the guidelines of the Ethics Committee of Shunde Hospital of Southern Medical University. Informed consent was obtained from the patient before the surgery for the data and video.

1. Patient selection

1. Apply this surgical method in the following cases:
   1. Include patients experiencing abdominal pain or discomfort, coupled with radiological examinations confirming the presence of benign lesions.
   2. Do not impose specific restrictio.......

Discussion

For years, total splenectomy was the primary treatment for splenic tumors, splenomegaly, and hematological disorders. However, with extensive cases followed up, complications after total splenectomy, including infectious complications and thromboembolic complications, have gradually aroused attention⁸. Overwhelming post-splenectomy infections (OPSIs) are the most severe complication after splenectomy, characterized by rapid disease progression with a mortality rate of approximately 50%

Materials

Name	Company	Catalog Number	Comments
Absorbable hemostat	Ethicon, LLC	W1913T
Disposable trocar	Kangji Medical	101Y.307,101Y.311
Endo bag	Medtronic	https://www.medtronic.com/covidien/en-us/search.html#q=endo%20bag	specimen bag
Jaw sealer/divider	Covidien Medical	LF1737
Laparoscopic radiofrequency device	AngioDynamics, Inc	Rita 700-103659
Laparoscopic system	Olympus	WM-NP2 L-RECORDOR-01
LigaSure	Medtronic	https://www.medtronic.com/covidien/en-us/products/vessel-sealing/ligasure-technology.html	vessel sealing system
Ligation clips (Hem-o-lok)	Teleflex Medical	544240,544230,544220
Ultrasonic scalpel	ETHICON Medical	HAR36