Laparoscopic Splenectomy

Laparoscopic Splenectomy George Ferzli, MD, FACS Department of Laparoscopic Surgery Staten Island University Hospital

Historical background ,[object Object],[object Object],[object Object],[object Object]

Open splenic surgery ,[object Object],[object Object],[object Object],[object Object]

Laparoscopic splenectomy ,[object Object],[object Object]

Spleen Anatomy ,[object Object],[object Object],[object Object]

Spleen Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Spleen Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Splenic Function ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Indications for splenectomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Change of Indications Decrease Increase ,[object Object],[object Object],[object Object],[object Object]

Personal experience (Indications) *6 patients with accessory spleen

Relative Contraindications to Laparoscopic Approach ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Laparoscopic versus open splenectomy* ,[object Object],[object Object],[object Object],[object Object],[object Object],*Donini et al. Surg Endosc (1999) 13:1220-1225

Three Areas of Controversy ,[object Object],[object Object],[object Object]

Massive splenomegaly ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],*Meijer et al J Laparoendosc & Adv Techn (1999) 9:507-10

Massive Splenomegaly Laparoscopy vs Open ,[object Object],[object Object],[object Object],[object Object],[object Object]

Massive Splenomegaly Laparoscopy vs Open

Laparoscopic Splenectomy for Ruptured Spleen ,[object Object],[object Object],[object Object],[object Object],[object Object]

Laparoscopic Splenectomy for Ruptured Spleen ,[object Object],[object Object],[object Object],[object Object]

Accessory spleens (AS) ,[object Object],[object Object]

Residual Splenic Function ,[object Object],[object Object],[object Object],[object Object],[object Object]

Residual Splenic Function ,[object Object],[object Object],[object Object],[object Object]

Prevention of Residual Function ,[object Object],[object Object]

Preoperative Considerations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Technique ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Technique 1) Splenic mobilization 2) Splenic hilum 3) Extraction after finger morcellation (depends on the anatomy)

Technique ,[object Object],[object Object],[object Object]

Technique ,[object Object],[object Object]

Post-op Considerations ,[object Object],[object Object],[object Object],[object Object],[object Object]

Personal experience Results * 50 days after surgery

Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusion ,[object Object],[object Object],[object Object]

Laparoscopic Splenectomy

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Laparoscopic Splenectomy